148 results on '"Wendy M. Troxel"'
Search Results
2. Longitudinal associations between sleep and BMI in a low-income, predominantly Black American sample
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Stephanie Brooks Holliday, Lu Dong, Ann Haas, Madhumita (Bonnie) Ghosh-Dastidar, Tamara Dubowitz, Daniel J. Buysse, Lauren Hale, and Wendy M. Troxel
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Behavioral Neuroscience - Abstract
Black individuals and those experiencing socioeconomic disadvantage are at increased risk for sleep problems and obesity. This study adds to the limited extant literature examining longitudinal associations between objectively measured sleep and changes in body mass index (BMI) in Black Americans.We focused on individuals with at least 1 observation of sleep and BMI at 1 of 3 study time points (2013, 2016, and 2018). We modeled longitudinal trends in BMI as a function of time, average of each sleep variable across assessments, and within-person deviations in each sleep variable over time.Data were collected via interviewer-administered at-home surveys and actigraphy in Pittsburgh, PA.Our sample comprised 1115 low-income, primarily Black adults, including 862 women and 253 men.Sleep measures included actigraphy-measured total sleep time, sleep efficiency, and wakefulness after sleep onset, as well as self-reported sleep quality. We also included objectively measured BMI.In models adjusted for age, gender, and other sociodemographic covariates (eg, income, marital status), there were no significant longitudinal associations between total sleep time, sleep efficiency, wakefulness after sleep onset, or subjective sleep quality and changes in BMI.This study provides further evidence that, among a sample of low-income Black adults, sleep problems are not longitudinally predictive of BMI. Although ample cross-sectional evidence demonstrates that sleep problems and obesity commonly co-occur, longitudinal evidence is mixed. Better understanding the overlap of sleep and obesity over time may contribute to prevention and intervention efforts.
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- 2023
3. Food insecurity, sleep, and cardiometabolic risks in urban American Indian/Alaska Native youth
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Lu Dong, Elizabeth J. D'Amico, Daniel L. Dickerson, Ryan A. Brown, Alina I. Palimaru, Carrie L. Johnson, and Wendy M. Troxel
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Behavioral Neuroscience - Abstract
Food insecurity contributes to racial/ethnic disparities in health. This is the first study to examine associations among food insecurity, sleep, and cardiometabolic outcomes in urban American Indian/Alaska Native (AI/AN) youth.Participants were 142 urban AI/AN youth (mean age = 14 years, 58% female). Food insecurity and self-reported sleep disturbance were measured using validated surveys. A multi-dimensional sleep health composite was derived using questionnaires (ie, satisfaction, alertness) and actigraphy-derived indices (ie, duration, efficiency, regularity, timing). Cardiometabolic measures included body mass index, blood pressure, glycosylated hemoglobin, waist circumference, cholesterol, and triglycerides. Covariates were sex, age, and single-parent household.Greater food insecurity was significantly associated with greater body mass index (b = 0.12, p = .015), higher systolic blood pressure (b = 0.93, p = .03), and greater sleep disturbance (b = 1.49, p.001), and marginally associated with lower sleep health composite scores (b = -0.09, p = .08). There was a significant indirect path from greater food insecurity to greater waist circumference through poorer sleep health (0.11, 95% bootstrapping CI: [0.01, 0.30]).Food insecurity is an important correlate of sleep and cardiometabolic health among urban AI/AN youth and should be addressed to reduce emerging health risks during this important developmental period. Policies to reduce food insecurity and increase access to healthy foods as well as sleep interventions for these youth could help, as preliminary findings suggest that sleep health may mediate the negative impact of food insecurity on cardiometabolic risks.
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- 2023
4. Neighborhood Built Environment and Sleep Health: A Longitudinal Study in Low-Income and Predominantly African-American Neighborhoods
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Byoungjun Kim, Wendy M Troxel, Tamara Dubowitz, Gerald P Hunter, Bonnie Ghosh-Dastidar, Basile Chaix, Kara E Rudolph, Christopher N Morrison, Charles C Branas, and Dustin T Duncan
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Epidemiology - Abstract
In the present study, we examined the associations between physical characteristics of neighborhoods and sleep health outcomes and assessed the mediating role of physical activity in these associations. A longitudinal study (the Pittsburgh Hill/Homewood Research on Eating, Shopping, and Health (PHRESH) Zzz Study; n = 1,051) was conducted in 2 low-income, predominately African-American neighborhoods in Pittsburgh, Pennsylvania, with repeated measures of neighborhood characteristics and sleep health outcomes from 2013 to 2018. Built environment measures of walkability, urban design, and neighborhood disorder were captured from systematic field observations. Sleep health outcomes included insufficient sleep, sleep duration, wakefulness after sleep onset, and sleep efficiency measured from 7-day actigraphy data. G-computations based on structural nested mean models were used to examine the total effects of each built environment feature, and causal mediation analyses were used to evaluate direct and indirect effects operating through physical activity. Urban design features were associated with decreased wakefulness after sleep onset (risk difference (RD) = −1.26, 95% confidence interval (CI): −4.31, −0.33). Neighborhood disorder (RD = −0.46, 95% CI: −0.86, −0.07) and crime rate (RD = −0.54, 95% CI: −0.93, −0.08) were negatively associated with sleep efficiency. Neighborhood walkability was not associated with sleep outcomes. We did not find a strong and consistent mediating role of physical activity. Interventions to improve sleep should target modifiable factors, including urban design and neighborhood disorder.
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- 2023
5. Changes in psychosocial wellbeing over a five-year period in two predominantly Black Pittsburgh neighbourhoods: A comparison between gentrifying and non-gentrifying census tracts
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Alexandra Mendoza-Graf, Rebecca L Collins, Madhumita Ghosh Dastidar, Robin Beckman, Gerald P Hunter, Wendy M Troxel, and Tamara Dubowitz
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Urban Studies ,Environmental Science (miscellaneous) - Abstract
Gentrification often leads to changes within urban neighbourhoods. While redevelopment and investment may improve the built environment in gentrifying neighbourhoods, there may be disruptive impacts that affect health and wellbeing for existing residents. A growing body of literature explores the impact of gentrification on the psychosocial wellbeing of residents. This study sought to understand gentrification’s effects on three aspects of psychosocial wellbeing in a random sample of predominantly Black residents in two neighbourhoods in Pittsburgh, Pennsylvania ( n = 662). Residents were enrolled in 2011 and surveyed multiple times through 2018. We used American Community Survey data to create a tract-level measure of gentrification to categorise the 13 census tracts in the two neighbourhoods as gentrified or not gentrified between 2011 and 2018 and assessed whether gentrified tracts experienced predominantly White or Black gentrification. We then estimated multivariate regression models to test associations between gentrification status and participant-level changes in perceived neighbourhood social cohesion, neighbourhood satisfaction and psychological distress, between 2013 and 2018. Relative to participants living in non-gentrified tracts, we found those living in gentrified tracts (all of which were Black gentrified) experienced smaller improvements in perceived neighbourhood social cohesion (coef. =−0.21, p = 0.005) and neighbourhood satisfaction (d y/d x = 0.12, p = 0.003). We found no statistically significant association between gentrification and changes in psychological distress. These results suggest that although gentrification may bring about needed resources in the community, further consideration should be given to help ensure any detrimental effects on social cohesion and neighbourhood satisfaction are mitigated.
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- 2023
6. Alcohol and Cannabis Use Within Emerging Adults’ Committed Romantic Relationships: Associations With Relationship Functioning and Quality of Life
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Joan S. Tucker, Wendy M. Troxel, Anthony Rodriguez, Rachana Seelam, and Elizabeth J. D’Amico
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Developmental and Educational Psychology ,Experimental and Cognitive Psychology ,Life-span and Life-course Studies - Abstract
This study examines alcohol and cannabis use within emerging adults’ committed romantic relationships and its association with relationship functioning (satisfaction, stability) and well-being (life satisfaction, anxiety, depression). Participants completed surveys in 2020 and 2021 ( N = 1214). Latent profile analysis identified four classes of couples’ substance use patterns: concordant (similar) infrequent use (81.9% of sample), near-daily partner cannabis use (6.0%), near-daily respondent cannabis use (6.5%), and concordant moderate alcohol and near-daily cannabis use (5.5%). Cross-sectionally, respondents who reported concordant infrequent use had significantly higher well-being than those who reported concordant heavier use; there were no class differences involving the two types of discordant couples. In general, class membership did not predict changes in well-being or relationship functioning over a 1-year period. Results provide new insights into patterns of both alcohol and cannabis use within committed romantic relationships of emerging adults that may have implications for well-being during this developmental period.
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- 2023
7. Multi-dimensional Profiles of Risk and Their Association with Obesity-Severity in Low-Income Black Women
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Andrea S. Richardson, Rebecca L. Collins, Bonnie Ghosh-Dastidar, Robin Beckman, Wendy M. Troxel, and Tamara Dubowitz
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Epidemiology ,Public Health, Environmental and Occupational Health - Published
- 2022
8. Job loss and psychological distress during the COVID‐19 pandemic: Longitudinal Analysis from residents in nine predominantly African American low‐income neighborhoods
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Matthew D. Baird, Jonathan Cantor, Wendy M. Troxel, and Tamara Dubowitz
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Black or African American ,Health Policy ,COVID-19 ,Humans ,Psychological Distress ,Pandemics ,Stress, Psychological - Abstract
While psychological distress is a common sequelae of job loss, how that relationship continued during the COVID-19 pandemic is unclear, for example, given higher health risk to working due to disease exposure. This paper examines changes in psychological distress depending on job loss among a cohort of randomly selected residents living in nine predominantly African American low-income neighborhoods in Pittsburgh PA across four waves between 2013 and 2020. Between 2013 and 2016, we found an increase in psychological distress after job loss in line with the literature. In contrast, between 2018 and 2020 we found change in psychological distress did not differ by employment loss. However, residents who had financial concerns and lost their jobs had the largest increases in psychological distress, while residents who did not have serious financial concerns-potentially due to public assistance-but experienced job loss had no increase in distress, a better outcome even than those that retained their jobs. Using partial identification, we find job loss during the pandemic decreased psychological distress for those without serious financial concerns. This has important policy implications for how high-risk persons within low-income communities are identified and supported, as well as what type of public assistance may help.
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- 2022
9. Sleep Disturbances, Changes in Sleep, and Cognitive Function in Low-Income African Americans
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Wendy M, Troxel, Ann, Haas, Tamara, Dubowitz, Bonnie, Ghosh-Dastidar, Meryl A, Butters, Tiffany L, Gary-Webb, Andrea M, Weinstein, and Andrea L, Rosso
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Male ,Sleep Wake Disorders ,General Neuroscience ,General Medicine ,Neuropsychological Tests ,Actigraphy ,Black or African American ,Psychiatry and Mental health ,Clinical Psychology ,Cognition ,Humans ,Cognitive Dysfunction ,Female ,Geriatrics and Gerontology ,Sleep ,Aged - Abstract
Background: Sleep problems may contribute to the disproportionate burden of Alzheimer’s disease and related dementias (ADRD) among African Americans (AAs). Objective: To examine the role of sleep problems in contributing to cognitive function and clinically adjudicated cognitive impairment in a predominantly AA sample. Methods: This study (n = 216, 78.8% female; mean age = 67.7 years) examined associations between 1) the level (i.e., measured in 2018) and 2) change over time (from 2013 to 2018; n = 168) in actigraphy-assessed sleep with domain-specific cognitive function and clinically adjudicated cognitive impairment (2018) in a community-dwelling, predominantly AA (96.9%) sample. A comprehensive cognitive battery assessed global cognitive function (3MS) and domain-specific cognitive function (attention, visuo-spatial ability, language, delayed recall, immediate recall, and executive function) in 2018. Sleep was measured in 2013 and 2018 via actigraphy. Results: Higher sleep efficiency and less wakefulness after sleep onset (WASO; measured in 2018) were associated with greater attention, executive function, and visuospatial ability. Increases in sleep efficiency between 2013 and 2018 were associated with better executive function, language, immediate recall, and visuospatial ability, whereas increases in WASO (2013–2018) were associated with poorer attention, executive function, and visuospatial ability. Level or change in sleep duration were not associated with domain-specific cognitive function, nor were any sleep measures associated with clinically adjudicated cognitive impairment. Conclusion: In a predominantly AA sample of older adults, both the level and change (i.e., worsening) of sleep efficiency and WASO were associated with poorer cognitive function. Improving sleep health may support ADRD prevention and reduce health disparities.
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- 2022
10. Design of the Think PHRESH longitudinal cohort study: Neighborhood disadvantage, cognitive aging, and Alzheimer’s disease risk in disinvested, Black neighborhoods
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Andrea L Rosso, Wendy M. Troxel, Tiffany L. Gary-Webb, Andrea M Weinstein, Meryl A. Butters, Alina Palimaru, Bonnie Ghosh-Dastidar, La’Vette Wagner, Alvin Nugroho, Gerald Hunter, Jennifer Parker, and Tamara Dubowitz
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Public Health, Environmental and Occupational Health - Abstract
Background Black Americans have disproportionately higher rates and earlier onset of Alzheimer’s disease and related dementias (ADRD) relative to White Americans. We currently lack a comprehensive understanding of how the lived experience and broader societal factors, including cumulative exposure to structural racism and the mechanisms underlying the risks, may contribute to elevated ADRD risk in Black Americans. Methods The Think PHRESH study builds on existing, community-based research infrastructure, from the ongoing Pittsburgh Hill/Homewood Research on Neighborhood Change and Health (PHRESH) studies, to examine the contributions of dynamic neighborhood socioeconomic conditions across the lifecourse to cognitive outcomes in mid- and late-life adults living in two historically disinvested, predominantly Black communities (anticipated n = 1133). This longitudinal, mixed-methods study rests on the premise that neighborhood racial segregation and subsequent disinvestment contributes to poor cognitive outcomes via factors including (a) low access to educational opportunities and (b) high exposure to race- and socioeconomically-relevant stressors, such as discrimination, trauma, and adverse childhood events. In turn, these cumulative exposures foster psychological vigilance in residents, leading to cardiometabolic dysregulation and sleep disruption, which may mediate associations between neighborhood disadvantage and ADRD risk. This premise recognizes the importance of potential protective factors that may promote cognitive health, including neighborhood social cohesion, safety, and satisfaction. The proposed study will leverage our existing longitudinal data on risk/protective factors and biobehavioral mediators and will include: (1) up to three waves of cognitive assessments in participants ages 50 years + and one assessment in participants ages 35–49 years; clinical adjudication of ADRD will be completed in participants who are 50+, (2) extensive surveys of risk and protective factors, (3) two assessments of blood pressure and objectively measured sleep, (4) a comprehensive assessment of life and residential history; and (5) two rounds of in-depth qualitative interviews to reveal lifecourse opportunities and barriers experienced by Black Americans in achieving optimal cognitive health in late life. Discussion Understanding how structural racism has influenced the lived experience of Black Americans, including dynamic changes in neighborhood conditions over time, is critical to inform multi-level intervention and policy efforts to reduce pervasive racial and socioeconomic disparities in ADRD.
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- 2023
11. Adolescent sleep health and school start times: Setting the research agenda for California and beyond. A research summit summary
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Terra D. Ziporyn, Judith A. Owens, Kyla L. Wahlstrom, Amy R. Wolfson, Wendy M. Troxel, Jared M. Saletin, Sonia L. Rubens, Rafael Pelayo, Phyllis A. Payne, Lauren Hale, Irena Keller, and Mary A. Carskadon
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Behavioral Neuroscience ,Schools ,Time Factors ,Adolescent ,Humans ,Sleep ,Students ,California - Abstract
In fall 2019, California passed and signed into law SB328, the first US statewide legislation explicitly designed to protect adolescent sleep health by requiring most California public school districts to start no earlier than 8:00 AM for middle schools and 8:30 AM for high schools. Recognizing the unique opportunity presented by the bill's 3-year implementation period, a group of experts in adolescent sleep and school start times held a virtual summit on January 22-23, 2021 to (1) summarize the research on adolescent sleep and school start time change; (2) develop recommendations for relevant, refined, and innovative research areas and research questions; (3) provide input regarding research design, methodology, and implementation; and (4) offer a forum for networking, exchanging ideas, and establishing interdisciplinary research collaborations. Participants represented a multidisciplinary range of academic backgrounds including sleep and circadian biology, neuroscience, education, medicine, public health, mental health, safety, public policy, economics, implementation science, criminology, diversity studies, and science communication. This paper summarizes summit presentations regarding current knowledge on adolescent sleep health and school start times and key research recommendations from small group workshops on topics including research design and tools, methodological issues, sleep health disparities, logistical challenges in conducting school-based research, public-health impact, and novel and expanded approaches to research.
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- 2022
12. Age Trends in Actigraphy and Self-Report Sleep Across the Life Span: Findings From the Pittsburgh Lifespan Sleep Databank
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Meredith L. Wallace, Nicholas Kissel, Martica H. Hall, Anne Germain, Karen A. Matthews, Wendy M. Troxel, Peter L. Franzen, Daniel J. Buysse, Charles Reynolds, Kathryn A. Roecklein, Heather E. Gunn, Brant P. Hasler, Tina R. Goldstein, Dana L. McMakin, Eva Szigethy, and Adriane M. Soehner
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Male ,Psychiatry and Mental health ,Cross-Sectional Studies ,Longevity ,Humans ,Female ,Self Report ,Sleep ,Actigraphy ,Article ,Applied Psychology - Abstract
Sleep changes over the human life span, and it does so across multiple dimensions. We used individual-level cross-sectional data to characterize age trends and sex differences in actigraphy and self-report sleep dimensions across the healthy human life span.The Pittsburgh Lifespan Sleep Databank consists of harmonized participant-level data from sleep-related studies conducted at the University of Pittsburgh (2003-2019). We included data from 1065 (n = 577 female; 21 studies) Pittsburgh Lifespan Sleep Databank participants aged 10 to 87 years without a major psychiatric, sleep, or medical condition. All participants completed wrist actigraphy and the self-rated Pittsburgh Sleep Quality Index. Main outcomes included actigraphy and self-report sleep duration, efficiency, and onset/offset timing, and actigraphy variability in midsleep timing.We used generalized additive models to examine potentially nonlinear relationships between age and sleep characteristics and to examine sex differences. Actigraphy and self-report sleep onset time shifted later between ages 10 and 18 years (23:03-24:10 [actigraphy]; 21:58-23:53 [self-report]) and then earlier during the 20s (00:08-23:40 [actigraphy]; 23:50-23:34 [self-report]). Actigraphy and self-report wake-up time also shifted earlier during the mid-20s through late 30s (07:48-06:52 [actigraphy]; 07:40-06:41 [self-report]). Self-report, but not actigraphy, sleep duration declined between ages 10 and 20 years (09:09-07:35). Self-report sleep efficiency decreased over the entire life span (96.12-93.28), as did actigraphy variability (01:54-01:31).Awareness of age trends in multiple sleep dimensions in healthy individuals-and explicating the timing and nature of sex differences in age-related change-can suggest periods of sleep-related risk or resilience and guide intervention efforts.
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- 2022
13. Changes in Sleep-Wake Patterns and Disturbances Before and During COVID-19 in Urban American Indian/ Alaska Native Adolescents
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Wendy M. Troxel, Alina I. Palimaru, David J. Klein, Lu Dong, Daniel L. Dickerson, Ryan A. Brown, Carrie L. Johnson, and Elizabeth J. D’Amico
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Male ,Sleep Wake Disorders ,Adolescent ,Neuroscience (miscellaneous) ,COVID-19 ,Medicine (miscellaneous) ,Alaskan Natives ,Article ,Humans ,Female ,Longitudinal Studies ,Neurology (clinical) ,Psychology (miscellaneous) ,Sleep ,American Indian or Alaska Native - Abstract
BACKGROUND: COVID-19 has profoundly affected sleep, although little research has focused on high-risk populations for poor sleep health, including American Indian/ Alaska Native (AI/AN) adolescents. METHODS: This is the first longitudinal study to examine changes in sleep with surveys completed before the pandemic and during the early months of COVID-19 in a sample of urban AI/AN adolescents (N=118; mean age= 14 years at baseline; 63% female). We use a mixed-methods approach to explore how COVID-19 affected urban AI/AN adolescents’ sleep, daily routines, and interactions with family and culture. Quantitative analysis examined whether pandemic-related sleep changes were significant and potential moderators of COVID-19’s effect on sleep, including family and community cohesion and engagement in traditional practices. RESULTS: Findings demonstrate changes in sleep, including increases in sleep duration, delays in bedtimes and waketimes, and increases in sleep-wake disturbances (p’s
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- 2022
14. Loneliness and multiple health domains: associations among emerging adults
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Lilian G. Perez, Daniel Siconolfi, Wendy M. Troxel, Joan S. Tucker, Rachana Seelam, Anthony Rodriguez, Regina A. Shih, and Elizabeth J. D’Amico
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Adult ,Loneliness ,Sexual Behavior ,Gender Identity ,Physical health ,Substance use ,Article ,Sexual and Gender Minorities ,Emerging adulthood ,Effect modification ,Psychiatry and Mental health ,Cross-Sectional Studies ,Humans ,Sleep ,General Psychology - Abstract
Emerging adults (18–25 years), particularly racially/ethnically diverse and sexual and gender minority populations, may experience loneliness following major life transitions. How loneliness relates to health and health disparities during this developmental period is not well understood. We examine associations of loneliness with physical (self-rated health), behavioral (alcohol/marijuana consequences; nicotine dependence), and health behavior outcomes (weekday and weekend sleep; trouble sleeping), and investigate moderating effects by sex, race/ethnicity, and sexual/gender minority (SGM) status. Adjusted models using cross-sectional data from 2,534 emerging adults, predominantly in California, examined associations between loneliness and each outcome and tested interactions of loneliness with sex, race/ethnicity, and SGM status. Higher loneliness was significantly associated with worse self-rated health, higher marijuana consequences, less weekday sleep, and greater odds of feeling bothered by trouble sleeping. None of the interactions were significant. Findings suggest that interventions to reduce loneliness may help promote healthy development among emerging adults across subgroups. Supplementary Information The online version contains supplementary material available at 10.1007/s10865-021-00267-1.
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- 2022
15. Examining the Cross-sectional Association Between Neighborhood Conditions, Discrimination, and Telomere Length in a Predominantly African American Sample
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Wendy M. Troxel, Jaime Madrigano, Ann C. Haas, Tamara Dubowitz, Andrea L. Rosso, Aric A. Prather, Madhumita Ghosh-Dastidar, Andrea M. Weinstein, Meryl A. Butters, Albert Presto, and Tiffany L. Gary-Webb
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Health (social science) ,Sociology and Political Science ,Health Policy ,Anthropology ,Public Health, Environmental and Occupational Health - Published
- 2023
16. Mixed Effects of Neighborhood Revitalization on Residents’ Cardiometabolic Health
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Matthew D. Baird, Stephanie Brooks Holliday, Wendy M. Troxel, Tiffany L. Gary-Webb, Tamara Dubowitz, Andy Bogart, and Bonnie Ghosh-Dastidar
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Adult ,Male ,Natural experiment ,Epidemiology ,media_common.quotation_subject ,Article ,Residence Characteristics ,Humans ,Medicine ,Poverty ,media_common ,African american ,Selection bias ,business.industry ,Public Health, Environmental and Occupational Health ,Middle Aged ,Causality ,Health equity ,Disadvantaged ,Black or African American ,Cross-Sectional Studies ,Blood pressure ,Cardiovascular Diseases ,Mixed effects ,Female ,business ,Demography - Abstract
Introduction Despite the growing recognition of the importance of neighborhood conditions for cardiometabolic health, causal relationships have been difficult to establish owing to a reliance on cross-sectional designs and selection bias. This is the first natural experiment to examine the impact of neighborhood revitalization on cardiometabolic outcomes in residents from 2 predominantly African American neighborhoods, one of which has experienced significant revitalization (intervention), whereas the other has not (comparison). Methods The sample included 532 adults (95% African American, 80% female, mean age=58.9 years) from 2 sociodemographically similar, low-income neighborhoods in Pittsburgh, PA, with preintervention and postintervention measures (2016 and 2018) of BMI, diastolic and systolic blood pressure, HbA1c, and high-density lipoprotein cholesterol and covariates. Data were collected in 2016 and 2018 and analyzed in 2020. Results Difference-in-difference analyses showed significant improvement in high-density lipoprotein cholesterol in intervention residents relative to that in the comparison neighborhood (β=3.88, 95% CI=0.47, 7.29). There was also a significant difference-in-difference estimate in diastolic blood pressure (β=3.00, 95% CI=0.57, 5.43), with residents of the intervention neighborhood showing a greater increase in diastolic blood pressure than those in the comparison neighborhood. No statistically significant differences were found for other outcomes. Conclusions Investing in disadvantaged neighborhoods has been suggested as a strategy to reduce health disparities. Using a natural experiment, findings suggest that improving neighborhood conditions may have a mixed impact on certain aspects of cardiometabolic health. Findings underscore the importance of examining the upstream causes of health disparities using rigorous designs and longer follow-up periods that provide more powerful tests of causality.
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- 2021
17. Neighborhood Food Environment Associated with Cardiometabolic Health among Predominately Low-income, Urban, Black Women
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Wendy M. Troxel, Tiffany L. Gary-Webb, Tamara Dubowitz, Gabrielle Corona, Bonny Rockette-Wagner, and Madhumita Ghosh-Dastidar
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Low income ,Black women ,education.field_of_study ,Epidemiology ,business.industry ,Population ,General Medicine ,Overweight ,Original Report: Social Determinants of Health ,Health outcomes ,Logistic regression ,Food Supply ,Odds ,Cross-Sectional Studies ,Cardiovascular Diseases ,Residence Characteristics ,Environmental health ,Vegetables ,Humans ,Medicine ,Female ,medicine.symptom ,business ,education ,Food environment - Abstract
Objectives: This study sought to: 1) understand how the perceived food environment (availability, accessibility, and affordability) is associated with cardiometabolic health outcomes in predominately low-income Black residents in urban neighborhoods with limited healthy food access; and 2) examine the association of shopping at specific store types with cardiometabolic health outcomes. Methods: We report on cross-sectional data from 459 individuals participating in the Pittsburgh, PA Hill/Homewood Research on Neighborhoods and Health (PHRESH) study. Mean participant age was 60.7 (SD=13.9); 81.7% were female. We used logistic regression to examine associations between three factors (perceived fruit and vegetable availability, quality, and price; primary food shopping store characteristics; and frequency of shopping at stores with low or high access to healthy foods) and cardiometabolic and self-rated health. Results: Adjusting for sociodemographic characteristics, participants with higher perceived fruit and vegetable accessibility (AOR:.47, 95%CI: .28-.79, P=.004) and affordability (AOR:.59, 95%CI: .36-.96, P=.034) had lower odds of high blood pressure. Shopping often (vs rarely) at stores with low access to healthy foods was associated with higher odds of high total cholesterol (AOR:3.52, 95%CI: 1.09-11.40, P=.035). Finally, primary food shopping at a discount grocery (vs full-service supermarket) was associated with lower odds of overweight/obesity (AOR:.51, 95%CI: .26-.99, P=.049). Conclusions: These results suggest that both perceived accessibility and affordability of healthy foods are associated with reduced cardiometabolic risk factors in this urban, low-income predominantly Black population. Additionally, discount grocery stores may be particularly valuable by providing access and affordability of healthy foods in this population. Ethn Dis. 2021;31(4):537-546; doi:10.18865/ed.31.4.537
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- 2021
18. Examining the diagnostic validity of the Berlin Questionnaire in a low-income Black American sample
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Madhumita Ghosh-Dastidar, Stephanie Brooks Holliday, Lu Dong, Lauren Hale, Tamara Dubowitz, Daniel J. Buysse, Ann C. Haas, and Wendy M. Troxel
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Male ,Pulmonary and Respiratory Medicine ,Low income ,Sleep Apnea, Obstructive ,business.industry ,Polysomnography ,Sample (statistics) ,medicine.disease ,Scientific Investigations ,Sensitivity and Specificity ,respiratory tract diseases ,Obstructive sleep apnea ,Increased risk ,Neurology ,Surveys and Questionnaires ,Diagnostic validity ,medicine ,Humans ,Mass Screening ,Female ,Neurology (clinical) ,business ,Socioeconomic status ,Demography - Abstract
STUDY OBJECTIVES: Black individuals and individuals of low socioeconomic status are at increased risk for obstructive sleep apnea (OSA). The Berlin Questionnaire is one of the most widely used screening tools for OSA; however, there is limited research on its diagnostic accuracy in low-income Black populations. METHODS: This study analyzed data from an ongoing study taking place among a cohort from 2 predominantly Black neighborhoods in Pittsburgh, Pennsylvania (96.3% Black, 79.6% female). The sample included 269 individuals without a prior diagnosis of OSA who completed the Berlin Questionnaire and also participated in a home sleep apnea test. An apnea-hypopnea index ≥ 15 events/h was used to identify individuals with moderate or severe OSA. RESULTS: 19.3% of individuals met criteria for moderate to severe OSA based on home sleep apnea test, while 31.2% of participants screened as high risk for OSA based on the overall Berlin index. Using apnea-hypopnea index ≥ 15 events/h as the reference standard, the Berlin Questionnaire had a sensitivity of 46.2%, specificity of 72.4%, positive predictive value of 28.6%, and negative predictive value of 84.9% among this sample. Analyses stratified by sex suggested that the Berlin Questionnaire had better diagnostic validity in women than men. CONCLUSIONS: The Berlin Questionnaire has lower sensitivity and positive predictive value in our sample than those observed in general population samples. The measure performed better among women, though a higher proportion of men fell into the moderate or severe OSA range based on the home sleep apnea test. Given the significant downstream consequences of OSA, utilizing screening tools that better detect OSA in Black communities is key. CITATION: Holliday SB, Haas A, Dong L, et al. Examining the diagnostic validity of the Berlin Questionnaire in a low-income Black American sample. J Clin Sleep Med. 2021;17(10):1987–1994.
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- 2021
19. Virtual special issue: Updates on school start times and adolescent sleep health
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Wendy M. Troxel and Lauren Hale
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Behavioral Neuroscience - Published
- 2022
20. Examining the Cross-sectional Association Between Neighborhood Conditions, Discrimination, and Telomere Length in a Predominantly African American Sample
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Wendy M, Troxel, Jaime, Madrigano, Ann C, Haas, Tamara, Dubowitz, Andrea L, Rosso, Aric A, Prather, Madhumita, Ghosh-Dastidar, Andrea M, Weinstein, Meryl A, Butters, Albert, Presto, and Tiffany L, Gary-Webb
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Disproportionate exposure to adverse neighborhood conditions and greater discrimination may contribute to health disparities among African Americans (AAs). We examined whether adverse neighborhood conditions, alone or in conjunction with discrimination, associate with shorter leukocyte telomere length among a predominantly AA cohort. The sample included 200 residents from two low-income neighborhoods (96% AA; mean age = 67 years). Perceived neighborhood conditions and discrimination were surveyed in 2018, and objective neighborhood conditions (total crime rate, neighborhood walkability, ambient air pollution (PM
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- 2022
21. Longitudinal Associations Between Changes in Cigarette Smoking and Alcohol Use, Eating Behavior, Perceived Stress, and Self-Rated Health in a Cohort of Low-Income Black Adults
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Erika Litvin Bloom, Tamara Dubowitz, Rebecca L. Collins, Andy Bogart, Wendy M. Troxel, Bonnie Ghosh-Dastidar, and Tiffany L. Gary-Webb
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Adult ,Longitudinal study ,Cigarette Smoking ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Longitudinal Studies ,030212 general & internal medicine ,General Psychology ,Self-rated health ,030505 public health ,business.industry ,Smoking ,Behavior change ,Feeding Behavior ,medicine.disease ,Obesity ,Health equity ,Psychiatry and Mental health ,Cohort ,medicine.symptom ,0305 other medical science ,business ,Body mass index ,Stress, Psychological ,Regular Articles ,Demography ,Dieting - Abstract
Background Black adults in the U.S. experience significant health disparities related to tobacco use and obesity. Conducting observational studies of the associations between smoking and other health behaviors and indicators among Black adults may contribute to the development of tailored interventions. Purpose We examined associations between change in cigarette smoking and alcohol use, body mass index, eating behavior, perceived stress, and self-rated health in a cohort of Black adults who resided in low-income urban neighborhoods and participated in an ongoing longitudinal study. Methods Interviews were conducted in 2011, 2014, and 2018; participants (N = 904) provided at least two waves of data. We fit linear and logistic mixed-effects models to evaluate how changes in smoking status from the previous wave to the subsequent wave were related to each outcome at that subsequent wave. Results Compared to repeated smoking (smoking at previous and subsequent wave), repeated nonsmoking (nonsmoking at previous and subsequent wave) was associated with greater likelihood of recent dieting (OR = 1.59, 95% CI [1.13, 2.23], p = .007) and future intention (OR = 2.19, 95% CI [1.61, 2.98], p < .001) and self-efficacy (OR = 1.64, 95% CI [1.21, 2.23], p = .002) to eat low calorie foods, and greater odds of excellent or very good self-rated health (OR = 2.47, 95% CI [1.53, 3.99], p < .001). Transitioning from smoking to nonsmoking was associated with greater self-efficacy to eat low calorie foods (OR = 1.89, 95% CI [1.1, 3.26], p = .021), and lower perceived stress (β = −0.69, 95% CI [−1.34, −0.05], p = .036). Conclusions We found significant longitudinal associations between smoking behavior and eating behavior, perceived stress, and self-rated health. These findings have implications for the development of multiple behavior change programs and community-level interventions and policies.
- Published
- 2021
22. Sleep Management in Posttraumatic Stress Disorder (PTSD): A Systematic Review
- Author
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Alicia Ruelaz, Maher, Eric, Apaydin, Lara, Hilton, Christine, Chen, Wendy M, Troxel, Owen, Hall, Gulrez Shah, Azhar, Jody, Larkin, Aneesa, Motala, and Susanne, Hempel
- Subjects
Mental Health - Abstract
Posttraumatic stress disorder (PTSD) is a condition that can emerge after exposure to a traumatic event. It involves several symptoms, including distressing memories or dreams and/or dissociative reactions; psychological distress at exposure to trauma cues; physiologic reactions to cues; avoidance of stimuli associated with the event; negative alterations in cognitions and mood associated with the trauma; and alterations in arousal and reactivity, including sleep disturbance. The purpose of this systematic review is to synthesize the evidence from randomized controlled trials on the effects that interventions for adults with PTSD have on sleep outcomes. The authors searched research databases and bibliographies of existing systematic reviews to identify pertinent trials published in English; literature was identified by the searches using predetermined eligibility criteria. The primary outcome domain included sleep quality, insomnia, and nightmares. Secondary outcomes were PTSD symptoms and adverse events. Risk of bias and the quality of evidence were assessed for each outcome. The identified interventions addressed pharmacological, psychological, behavioral, complementary, and integrative medicine treatments aimed at improving sleep or lessening other PTSD symptoms. Interventions in general showed an effect on sleep. Interventions explicitly targeting sleep—particularly psychotherapy targeting sleep—showed larger effects on sleep than did interventions not targeting sleep. Heterogeneity was considerable, but sleep effect estimates were not systematically affected by trauma type, setting, or modality. Comparative effectiveness studies are needed to support the findings.
- Published
- 2022
23. Multi-dimensional Profiles of Risk and Their Association with Obesity-Severity in Low-Income Black Women
- Author
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Andrea S, Richardson, Rebecca L, Collins, Bonnie, Ghosh-Dastidar, Robin, Beckman, Wendy M, Troxel, and Tamara, Dubowitz
- Subjects
Cross-Sectional Studies ,Socioeconomic Factors ,Residence Characteristics ,Humans ,Female ,Obesity ,Poverty ,Diet - Abstract
Multi-level risk factors underlie disproportionate obesity rates among Black women. Latent class analysis of multi-level risk and protective factors among low-income Black women (n = 917) in 2011 (Pittsburgh, PA). Data were collected via in-person survey, interviewer-assisted online dietary recalls, and from 2011 crime records. Multinomial logistic regression estimated cross-sectional associations between latent classes and obesity severity derived from measured anthropometry. Latent class analysis identified four groups of women according to their motivations and intentions to be healthy, socioeconomic and health burden, and neighborhood risk: Class 1 = Very high burden (n = 283), Class 2 = Health motivated, low burden, low neighborhood risk (n = 231), Class 3 = High burden and high neighborhood risk (n = 106), and Class 4 = Low burden and low neighborhood risk (n = 297). Class 3 = High burden and high neighborhood risk women had the highest severe obesity risk. Multi-level strategies may support low-income Black women women's resilience to obesity who face neighborhood-level and socioeconomic stressors.
- Published
- 2022
24. Sleep Health Among Adolescents and Adults During the COVID-19 Pandemic: Introduction to the Special Issue
- Author
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Wendy M. Troxel
- Subjects
Adult ,Sleep Wake Disorders ,Adolescent ,Neuroscience (miscellaneous) ,Medicine (miscellaneous) ,COVID-19 ,Humans ,Neurology (clinical) ,Psychology (miscellaneous) ,Sleep ,Pandemics - Published
- 2022
25. Greenspace redevelopment, pressure of displacement, and sleep quality among Black adults in Southwest Atlanta
- Author
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Christopher Coutts, Akil-Vuai Gregory, Zipporah Davis, Wendy M. Troxel, Terrence Alexander, Raven Proby, Robert T. Krafty, and Patrice C. Williams
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Adult ,Epidemiology ,Parks, Recreational ,media_common.quotation_subject ,Pressure of displacement ,Toxicology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Residence Characteristics ,Environmental health ,Humans ,Quality (business) ,030212 general & internal medicine ,Social environmental stressors ,Association (psychology) ,media_common ,biology ,Stressor ,Public Health, Environmental and Occupational Health ,Sleep quality ,Black adults ,Displacement (psychology) ,biology.organism_classification ,Pollution ,Black or African American ,Greenspace redevelopment ,Atlanta ,Redevelopment ,Housing ,Survey data collection ,Atlanta BeltLine ,Sleep ,Psychology ,030217 neurology & neurosurgery ,Vigilance (psychology) - Abstract
Background Little is known on how greenspace redevelopment—creating or improving existing parks and trails—targeted for low-income and/or majority Black neighborhoods could amplify existing social environmental stressors, increase residents’ susceptibility to displacement, and impact their sleep quality. Objective To examine the relationship between social environmental stressors associated with displacement and sleep quality among Black adults. Methods Linear regression models were employed on survey data to investigate the association between social environmental stressors, independently and combined, on sleep quality among Black adults residing in block groups targeted for greenspace redevelopment (i.e., exposed) and matched with block groups that were not (i.e., unexposed). Results The independent associations between everyday discrimination, heightened vigilance, housing unaffordability, and subjective sleep quality were not modified by greenspace redevelopment, controlling for other factors. The association between financial strain and subjective sleep quality was different for exposed and unexposed participants with exposed participants having a poorer sleep quality. The combined model revealed that the association between financial strain and sleep quality persisted. However, for different financial strain categories exposed participants slept poorer and/or better than unexposed participants. Significance Our findings suggest a nuanced relationship between social environmental stressors, pressure of displacement related to greenspace redevelopment, and sleep quality among Black adults.
- Published
- 2021
26. Food Insecurity in a Low-Income, Predominantly African American Cohort Following the COVID-19 Pandemic
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Rebecca L. Collins, Jonathan Cantor, Wendy M. Troxel, Gerald P. Hunter, Madhumita Ghosh Dastidar, Sameer M. Siddiqi, Tamara Dubowitz, Robin L. Beckman, Alexandra Mendoza-Graf, Alvin Kristian Nugroho, Andrea S. Richardson, and Matthew D. Baird
- Subjects
African american ,Research & Analysis ,Poverty ,Coronavirus disease 2019 (COVID-19) ,SARS-CoV-2 ,Public Health, Environmental and Occupational Health ,COVID-19 ,Pennsylvania ,Supplemental Nutrition Assistance Program ,United States ,Black or African American ,Food insecurity ,Food Insecurity ,Geography ,Residence Characteristics ,Risk Factors ,Pandemic ,Cohort ,Food desert ,Humans ,Longitudinal Studies ,Pandemics ,Demography - Abstract
Objectives. To examine the impact of COVID-19 shutdowns on food insecurity among a predominantly African American cohort residing in low-income racially isolated neighborhoods. Methods. Residents of 2 low-income African American food desert neighborhoods in Pittsburgh, Pennsylvania, were surveyed from March 23 to May 22, 2020, drawing on a longitudinal cohort (n = 605) previously followed from 2011 to 2018. We examined longitudinal trends in food insecurity from 2011 to 2020 and compared them with national trends. We also assessed use of food assistance in our sample in 2018 versus 2020. Results. From 2018 to 2020, food insecurity increased from 20.7% to 36.9% (t = 7.63; P Conclusions. Longitudinal data highlight profound inequities that have been exacerbated by COVID-19. Existing policies appear inadequate to address the widening gap.
- Published
- 2021
27. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline
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Wendy M. Troxel, Jack D. Edinger, J. Todd Arnedt, Colleen E. Carney, Uzma Kazmi, Jonathan L. Heald, Michael J. Sateia, John J. Harrington, Eric S. Zhou, Suzanne M. Bertisch, Jennifer L. Martin, and Kenneth L. Lichstein
- Subjects
Adult ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Sleep medicine ,03 medical and health sciences ,0302 clinical medicine ,Physicians ,Sleep Initiation and Maintenance Disorders ,medicine ,Humans ,GRADE Approach ,Psychiatry ,Psychological treatment ,Cognitive Behavioral Therapy ,business.industry ,Academies and Institutes ,Behavioral treatment ,Guideline ,United States ,Clinical Practice ,Chronic insomnia ,Neurology ,Special Articles ,Neurology (clinical) ,Sleep ,business ,030217 neurology & neurosurgery - Abstract
INTRODUCTION: This guideline establishes clinical practice recommendations for the use of behavioral and psychological treatments for chronic insomnia disorder in adults. METHODS: The American Academy of Sleep Medicine (AASM) commissioned a task force of experts in sleep medicine and sleep psychology to develop recommendations and assign strengths based on a systematic review of the literature and an assessment of the evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The task force evaluated a summary of the relevant literature and the quality of evidence, the balance of clinically relevant benefits and harms, patient values and preferences, and resource use considerations that underpin the recommendations. The AASM Board of Directors approved the final recommendations. RECOMMENDATIONS: The following recommendations are intended as a guide for clinicians in choosing a specific behavioral and psychological therapy for the treatment of chronic insomnia disorder in adult patients. Each recommendation statement is assigned a strength (“strong” or “conditional”). A “strong” recommendation (ie, “We recommend…”) is one that clinicians should follow under most circumstances. A “conditional” recommendation is one that requires that the clinician use clinical knowledge and experience, and to strongly consider the patient’s values and preferences to determine the best course of action. 1. We recommend that clinicians use multicomponent cognitive behavioral therapy for insomnia for the treatment of chronic insomnia disorder in adults. (STRONG). 2. We suggest that clinicians use multicomponent brief therapies for insomnia for the treatment of chronic insomnia disorder in adults. (CONDITIONAL). 3. We suggest that clinicians use stimulus control as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL). 4. We suggest that clinicians use sleep restriction therapy as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL). 5. We suggest that clinicians use relaxation therapy as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL). 6. We suggest that clinicians not use sleep hygiene as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL). CITATION: Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021;17(2):255–262.
- Published
- 2021
28. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment
- Author
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Suzanne M. Bertisch, Michael J. Sateia, Kenneth L. Lichstein, Colleen E. Carney, Jonathan L. Heald, Eric S. Zhou, Jennifer L. Martin, John J. Harrington, J. Todd Arnedt, Wendy M. Troxel, Jack D. Edinger, and Uzma Kazmi
- Subjects
Adult ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Sleep medicine ,03 medical and health sciences ,0302 clinical medicine ,Sleep Initiation and Maintenance Disorders ,mental disorders ,medicine ,Humans ,GRADE Approach ,Review Articles ,Cognitive Behavioral Therapy ,business.industry ,Academies and Institutes ,Guideline ,United States ,Clinical Practice ,Chronic insomnia ,Neurology ,Meta-analysis ,Neurology (clinical) ,Sleep ,business ,030217 neurology & neurosurgery ,Clinical psychology - Abstract
INTRODUCTION: The purpose of this systematic review is to provide supporting evidence for a clinical practice guideline on the use of behavioral and psychological treatments for chronic insomnia disorder in adult populations. METHODS: The American Academy of Sleep Medicine commissioned a task force of 9 experts in sleep medicine and sleep psychology. A systematic review was conducted to identify randomized controlled trials that addressed behavioral and psychological interventions for the treatment of chronic insomnia disorder in adults. Statistical analyses were performed to determine if the treatments produced clinically significant improvements in a range of critical and important outcomes. Finally, the Grading of Recommendations Assessment, Development, and Evaluation process was used to evaluate the evidence for making specific treatment recommendations. RESULTS: The literature search identified 1,244 studies; 124 studies met the inclusion criteria, and 89 studies provided data suitable for statistical analyses. Evidence for the following interventions is presented in this review: cognitive-behavioral therapy for insomnia, brief therapies for insomnia, stimulus control, sleep restriction therapy, relaxation training, sleep hygiene, biofeedback, paradoxical intention, intensive sleep retraining, and mindfulness. This review provides a detailed summary of the evidence along with the quality of evidence, the balance of benefits vs harms, patient values and preferences, and resource use considerations. CITATION: Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2021;17(2):263–298.
- Published
- 2021
29. Mediating role of psychological distress in the associations between neighborhood social environments and sleep health
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Byoungjun Kim, Wendy M Troxel, Tamara Dubowitz, Gerald P Hunter, Bonnie Ghosh-Dastidar, Basile Chaix, Kara E Rudolph, Christopher N Morrison, Charles C Branas, and Dustin T Duncan
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Physiology (medical) ,Neurology (clinical) - Abstract
Study Objectives The characteristics of neighborhood social environments, such as safety and social cohesion, have been examined as determinants of poor sleep. The current study investigates associations between neighborhood social characteristics and sleep health, as well as the mediating role of psychological distress on these possible associations. Methods Three waves of PHRESH Zzz (n = 2699), a longitudinal study conducted in two low-income, predominately Black neighborhoods, were utilized for this analysis. The characteristics of neighborhood social environments were measured using crime rates, a neighborhood social disorder index, and self-reported social cohesion. Sleep health was measured via 7 days of wrist-worn actigraphy as insufficient sleep, sleep duration, wake after sleep onset (WASO), and sleep efficiency. G-estimations based on structural nested mean models and mediation analyses were performed to estimate the effects of neighborhood social environments on sleep as well as direct/indirect effects through psychological distress. Results Crime rate around residential addresses was associated with increased risk of insufficient sleep (risk ratio: 1.05 [1.02, 1.12]), increased WASO (β: 3.73 [0.26, 6.04]), and decreased sleep efficiency (β: −0.54 [−0.91, −0.09]). Perceived social cohesion was associated with decreased risk of insufficient sleep (OR: 0.93 [0.88, 0.97]). Psychological distress mediated part of the associations of crime and social cohesion with insufficient sleep. Conclusions Neighborhood social environments may contribute to poor sleep health in low-income, predominantly Black neighborhoods, and psychological distress can be a salient pathway linking these neighborhood characteristics and sleep health.
- Published
- 2022
30. Improvements in Neighborhood Socioeconomic Conditions May Improve Resident Diet
- Author
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Jennifer Sloan, Wendy M. Troxel, Andrea S. Richardson, Matthew D. Baird, Gerald P. Hunter, Heather L. Schwartz, Bonnie Ghosh-Dastidar, Alvin Kristian Nugroho, Feifei Ye, Rebecca L. Collins, Tiffany L. Gary-Webb, Tamara Dubowitz, and Robin L. Beckman
- Subjects
Adult ,Male ,Natural experiment ,Epidemiology ,030209 endocrinology & metabolism ,Negative association ,Structural equation modeling ,Body Mass Index ,03 medical and health sciences ,0302 clinical medicine ,Residence Characteristics ,Poverty Areas ,Environmental health ,Humans ,030212 general & internal medicine ,Socioeconomic status ,Aged ,Aged, 80 and over ,Models, Statistical ,Ownership ,Original Contribution ,Middle Aged ,Pennsylvania ,Dietary behavior ,Confidence interval ,Black or African American ,Food Insecurity ,Socioeconomic Factors ,Diet quality ,Mental Recall ,Female ,Diet, Healthy ,Erratum ,Psychology - Abstract
Neighborhood socioeconomic conditions (NSECs) are associated with resident diet, but most research has been cross-sectional. We capitalized on a natural experiment in Pittsburgh, Pennsylvania, in which 1 neighborhood experienced substantial investments and a sociodemographically similar neighborhood that did not, to examine pathways from neighborhood investments to changed NSECs and changed dietary behavior. We examined differences between renters and homeowners. Data were from a random sample of households (n = 831) in each of these low-income Pittsburgh neighborhoods that were surveyed in 2011 and 2014. Structural equation modeling tested direct and indirect pathways from neighborhood to resident dietary quality, adjusting for individual-level sociodemographics, with multigroup testing by homeowners versus renters. Neighborhood investments were directly associated with improved dietary quality for renters (β = 0.27, 95% confidence interval (CI): 0.05, 0.50) and homeowners (β = 0.51, 95% CI: 0.10, 0.92). Among renters, investments also were associated with dietary quality through a positive association with commercial prices (β = 0.34, 95% CI: 0.15, 0.54) and a negative association with residential prices (β = −0.30, 95% CI: −0.59, −0.004). Among homeowners, we did not observe any indirect pathways from investments to dietary quality through tested mediators. Investing in neighborhoods may support resident diet through improvements in neighborhood commercial environments for renters, but mechanisms appear to differ for homeowners.
- Published
- 2020
31. Prevalence and correlates of obstructive sleep apnea in urban-dwelling, low-income, predominantly African-American women
- Author
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Lauren Hale, Daniel J. Buysse, Ann C. Haas, Madhumita Ghosh-Dastidar, Stephanie Brooks Holliday, Wendy M. Troxel, Tamara Dubowitz, Tiffany L. Gary-Webb, and Lu Dong
- Subjects
Adult ,Male ,Low income ,Urban Population ,Polysomnography ,Article ,03 medical and health sciences ,0302 clinical medicine ,Prevalence ,medicine ,Humans ,African american ,Sleep Apnea, Obstructive ,business.industry ,Sleep apnea ,Actigraphy ,General Medicine ,Middle Aged ,Anthropometry ,medicine.disease ,Sleep in non-human animals ,nervous system diseases ,respiratory tract diseases ,Black or African American ,Obstructive sleep apnea ,Blood pressure ,030228 respiratory system ,Female ,business ,030217 neurology & neurosurgery ,Demography - Abstract
Study objectives The current study examined the prevalence and correlates of obstructive sleep apnea in a sample of low-income, predominantly African-American women using two waves of data. Methods Participants were adults from two urban neighborhoods who enrolled in the PHRESH Zzz Study (N = 828; Pittsburgh Hill/Homewood Research on Neighborhoods, Sleep, and Health). A subsample who reported never receiving OSA diagnosis completed home sleep apnea testing in 2016 (n = 269, mean age 55.0 years, 79.6% female) and again in 2018 (n = 135). Correlates of OSA tested included demographic and anthropometric variables, health behavior/conditions, psychological distress and general health, smoking status, actigraphy-measured sleep, and neighborhood factors measured at baseline. Results 18.0% of all 2016 participants reported receiving physician diagnoses of OSA. Among those who completed in–home assessment, 19.3% had AHI ≥15 and 33.8% had AHI ≥5 plus one or more sleep symptoms. Estimates of the prevalence of OSA in all 2016 participants were 33.8%–45.7% based on physician diagnoses and AHI results, depending on the criteria used. Age, gender, BMI, blood pressure, habitual snoring, neighborhood walkability, actigraphy-measured sleep characteristics, and smoking were concurrently associated with OSA in 2016. Changes in AHI categories from 2016 to 2018 were documented. Conclusions Low-income African Americans, including women, are a high-risk group for OSA, but remain under-diagnosed and under-treated. The current findings show a high prevalence of OSA in African-American women and are among the first to demonstrate that both individual and neighborhood factors are implicated in OSA prevalence.
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- 2020
32. Sleep Health: An Opportunity for Public Health to Address Health Equity
- Author
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Lauren Hale, Daniel J. Buysse, and Wendy M. Troxel
- Subjects
Gerontology ,medicine.medical_specialty ,Social Determinants of Health ,Population ,Psychological intervention ,Health Promotion ,Disease ,Article ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,sleep health ,030212 general & internal medicine ,sleep ,education ,health disparities ,education.field_of_study ,Health Equity ,Public health ,public health ,Public Health, Environmental and Occupational Health ,Health Status Disparities ,General Medicine ,Mental health ,Health equity ,Alertness ,Health promotion ,Psychology ,030217 neurology & neurosurgery - Abstract
The concept of sleep health provides a positive holistic framing of multiple sleep characteristics, including sleep duration, continuity, timing, alertness, and satisfaction. Sleep health promotion is an underrecognized public health opportunity with implications for a wide range of critical health outcomes, including cardiovascular disease, obesity, mental health, and neurodegenerative disease. Using a socioecological framework, we describe interacting domains of individual, social, and contextual influences on sleep health. To the extent that these determinants of sleep health are modifiable, sleep and public health researchers may benefit from taking a multilevel approach for addressing disparities in sleep health. For example, in addition to providing individual-level sleep behavioral recommendations, health promotion interventions need to occur at multiple contextual levels (e.g., family, schools, workplaces, media, and policy). Because sleep health, a key indicator of overall health, is unevenly distributed across the population, we consider improving sleep health a necessary step toward achieving health equity.
- Published
- 2020
33. Broken Windows, Broken Zzs: Poor Housing and Neighborhood Conditions Are Associated with Objective Measures of Sleep Health
- Author
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Lauren Hale, Daniel J. Buysse, Wendy M. Troxel, Bonnie Ghosh-Dastidar, Matthew P. Buman, Stephanie Brooks Holliday, Andrea S. Richardson, Ann C. Haas, Tiffany L. Gary-Webb, Tamara Dubowitz, and Heather L. Schwartz
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Health (social science) ,Article ,03 medical and health sciences ,0302 clinical medicine ,Residence Characteristics ,Sleep Initiation and Maintenance Disorders ,Humans ,Medicine ,030212 general & internal medicine ,Poverty ,Socioeconomic status ,Aged ,Aged, 80 and over ,030505 public health ,Public Housing ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,Actigraphy ,Middle Aged ,Pennsylvania ,Sleep in non-human animals ,Health equity ,Black or African American ,Urban Studies ,Distress ,Socioeconomic Factors ,Multivariate Analysis ,Female ,Sleep diary ,Crime ,Self Report ,Sleep onset ,0305 other medical science ,business ,Demography - Abstract
African Americans and socioeconomically disadvantaged individuals have higher rates of a variety of sleep disturbances, including short sleep duration, poor sleep quality, and fragmented sleep. Such sleep disturbances may contribute to pervasive and widening racial and socioeconomic (SES) disparities in health. A growing body of literature demonstrates that over and above individual-level SES, indicators of neighborhood disadvantage are associated with poor sleep. However, there has been scant investigation of the association between sleep and the most proximal environments, the home and residential block. This is the first study to examine the association between objective and self-reported measures of housing and block conditions and sleep. The sample included 634 adults (mean age = 58.7 years; 95% African American) from two low-income urban neighborhoods. Study participants reported whether they experienced problems with any of seven different housing problems (e.g., broken windows) and rated the overall condition of their home. Trained data collectors rated residential block quality. Seven days of wrist actigraphy were used to measure average sleep duration, efficiency, and wakefulness after sleep onset (WASO), and a sleep diary assessed sleep quality. Multivariate regression analyses were conducted for each sleep outcome with housing or block conditions as predictors in separate models. Participants reporting “fair” or “poor” housing conditions had an adjusted average sleep duration that was 15.4 min shorter than that of participants reporting “good” or “excellent” conditions. Those reporting any home distress had 15.9 min shorter sleep and .19 units lower mean sleep quality as compared with participants who did not report home distress. Poor objectively measured block quality was associated with 14.0 min shorter sleep duration, 1.95% lower sleep efficiency, and 10.7 additional minutes of WASO. Adverse housing and proximal neighborhood conditions are independently associated with poor sleep health. Findings highlight the importance of considering strategies that target upstream determinants of sleep health disparities.
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- 2020
34. Neighborhood social environment change in late adolescence predicts substance use in emerging adulthood
- Author
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Lilian G. Perez, Joan S. Tucker, Eric R. Pedersen, Wendy M. Troxel, Anthony Rodriguez, Caislin L. Firth, Rachana Seelam, Regina A. Shih, and Elizabeth J. D'Amico
- Subjects
Adult ,Health (social science) ,Adolescent ,Alcohol Drinking ,Residence Characteristics ,Substance-Related Disorders ,Geography, Planning and Development ,Public Health, Environmental and Occupational Health ,Humans ,Marijuana Smoking ,Social Environment ,Peer Group - Abstract
This study examines associations of changes in perceived and objective (census-based) neighborhood social environment variables during adolescence with alcohol and marijuana outcomes in emerging adulthood using two waves of data (2013-14 and 2019-20) from a cohort in Southern California (n = 1249). Increasing perceived disorganization predicted greater alcohol consequences and socialization with peers using marijuana. Decreasing objective neighborhood SES predicted fewer alcohol consequences and greater socialization with peers drinking alcohol. Unexpectedly, both decreasing and increasing perceived social cohesion predicted fewer alcohol consequences. Increasing perceived social cohesion predicted lower solitary alcohol use. Findings identify potential environmental targets to prevent substance use during the transition to emerging adulthood, but more research is warranted to understand the complex findings for alcohol consequences.
- Published
- 2022
35. Examining the Impact of Employment Status on Sleep Quality During the COVID-19 Pandemic in Two Low-Income Neighborhoods in Pittsburgh, PA
- Author
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Matthew D Baird, Tamara Dubowitz, Jonathan Cantor, and Wendy M Troxel
- Subjects
Employment ,AcademicSubjects/SCI01870 ,COVID-19 ,socioeconomic status ,Sleep Quality ,Residence Characteristics ,Physiology (medical) ,Humans ,Original Article ,Neurology (clinical) ,AcademicSubjects/MED00385 ,sleep ,job loss ,Pandemics ,AcademicSubjects/MED00370 ,health disparities ,Aged - Abstract
Study Objectives African Americans have faced disproportionate socioeconomic and health consequences associated with the COVID-19 pandemic. The current study examines employment and its association with sleep quality during the initial months of the pandemic in a low-income, predominantly African American adult sample. Methods In the early months of COVID-19 (March to May 2020), we administered a survey to an ongoing, longitudinal cohort of older adults to assess the impact of COVID-related changes in employment on self-reported sleep quality (N = 460; 93.9% African American). Participants had prior sleep quality assessed in 2018 and a subset also had sleep quality assessed in 2013 and 2016. Primary analyses focused on the prevalence of poor sleep quality and changes in sleep quality between 2018 and 2020, according to employment status. Financial strain and prior income were assessed as moderators of the association between employment status and sleep quality. We plotted trend lines showing sleep quality from 2013 to 2020 in a subset (n = 339) with all four waves of sleep data available. Results All participants experienced increases in poor sleep quality between 2018 and 2020, with no statistical differences between the employment groups. However, we found some evidence of moderation by financial strain and income. The trend analysis demonstrated increases in poor sleep quality primarily between 2018 and 2020. Conclusions Sleep quality worsened during the pandemic among low-income African American adults. Policies to support the financially vulnerable and marginalized populations could benefit sleep quality.
- Published
- 2022
36. Differential item functioning of the Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA) by race/ethnicity
- Author
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Anthony Rodriguez, Regina A. Shih, Wendy M. Troxel, and Elizabeth J. D’Amico
- Subjects
Sociology and Political Science ,Social Psychology ,Business and International Management - Published
- 2023
37. A latent class approach to understanding longitudinal sleep health and the association with alcohol and cannabis use during late adolescence and emerging adulthood
- Author
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Wendy M. Troxel, Anthony Rodriguez, Rachana Seelam, Lu Dong, Lilian G. Perez, Joan S. Tucker, Daniel Siconolfi, and Elizabeth J. D'Amico
- Subjects
Psychiatry and Mental health ,Clinical Psychology ,Medicine (miscellaneous) ,Toxicology - Abstract
Sleep is a multi-dimensional health behavior associated with elevated risk of substance use. This is the first study to utilize a latent class approach to characterize sleep health across multiple dimensions and across time from late adolescence to emerging adulthood, and to examine associations with alcohol and cannabis use trajectories.The sample included 2995 emerging adults (mean ages = 18 to 24 years across six waves of data collection; 54% female) who provided data on sleep dimensions (quality, duration, and social jetlag) and frequency and consequences of alcohol and cannabis use. Longitudinal latent class analysis (LLCA) models characterized participants according to the three sleep dimensions. Latent growth models examined trajectories of frequency and consequences of alcohol or cannabis use over time among emergent sleep classes, with and without controlling for covariates.LLCA models identified four sleep classes: good sleepers (n = 451; 15.2%); untroubled poor sleepers (n = 1024; 34.2%); troubled, moderately good sleepers (n = 1056; 35.3%); and suboptimal sleepers (n = 460; 15.4%). Good sleepers reported significantly lower levels of alcohol or cannabis use and consequences, and less of an increase in alcohol consequences as compared to suboptimal sleepers.Persistent poor sleep health was associated with higher levels of alcohol and cannabis use and consequences, and greater increases in alcohol-related consequences during the transition from late adolescence to emerging adulthood. Findings have important clinical implications, highlighting that addressing multi-dimensional sleep health may be an important, novel target of intervention to reduce substance use frequency and consequences.
- Published
- 2022
38. Leaning in to Address Sleep Disturbances and Sleep Disorders in Department of Defense and Defense Health Agency
- Author
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Vincent Mysliwiec, Matthew S Brock, Jennifer L Creamer, Emmanuel P Espejo, Rachel R Markwald, Gregory N Matwiyoff, John T Peachey, Brian M O’Reilly, Nita L Shattuck, Daniel J Taylor, Wendy M Troxel, Anne Germain, Human Systems Integration Program, Naval Postgraduate School (U.S.), and Operations Research (OR)
- Subjects
Sleep Wake Disorders ,Military Personnel ,Public Health, Environmental and Occupational Health ,Humans ,General Medicine ,Sleep - Abstract
Letter to the Editor, Military Medicine, 187, 5/6:155, 2022 17 USC 105 interim-entered record; under review. The article of record as published may be found at http://dx.doi.org/10.1177/0018720820906050 In their article entitled, “Engaging Stakeholders to Optimize Sleep Disorders Management in the U.S. Military: A Qualitative Analysis,” Abdelwadoud and colleagues conducted focus groups of service members, primary care managers (PCMs), and administrative stakeholders about their perceptions, experiences, roles in sleep management, stated education needs, and management of sleep disorders.1 The qualitative methods are rigorous, and the findings reinforce and nuance prior results, especially regarding key requirements from PCMs. We feel compelled, however, to further nuance the authors’ conclusion that “current military sleep management practices are neither satisfactory nor maximally effective” and offer specific examples of actions taken by the Department of Defense (DoD) and Defense Health Agency (DHA) in recognition of the significance of optimal sleep in combat readiness and overall health of service members. We offer here a succinct list of concrete efforts to support and implement substantial clinical, operational, research, or educational efforts by the DoD or DHA to improve sleep in service members and associated clinical challenges in this unique population. Identified in text as U.S. Government work.
- Published
- 2021
39. Does Large-Scale Neighborhood Reinvestment Work? Effects of Public–Private Real Estate Investment on Local Sales Prices, Rental Prices, and Crime Rates
- Author
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Tiffany L. Gary-Webb, Bonnie Ghosh-Dastidar, Tamara Dubowitz, Gerald P. Hunter, Heather L. Schwartz, Matthew D. Baird, and Wendy M. Troxel
- Subjects
Public housing ,business.industry ,HOPE VI ,media_common.quotation_subject ,05 social sciences ,Economic rent ,0211 other engineering and technologies ,021107 urban & regional planning ,Real estate ,02 engineering and technology ,Management, Monitoring, Policy and Law ,Development ,Investment (macroeconomics) ,Article ,Agricultural economics ,Urban Studies ,Renting ,Scale (social sciences) ,Redevelopment ,0502 economics and business ,Business ,050207 economics ,media_common - Abstract
During the 1990s, the U.S. Department of Housing and Urban Development awarded more than $6 billion in competitive grants called HOPE VI to spur neighborhood redevelopment. We add to HOPE VI research by examining the impacts of a large set of public-private real estate investments, including HOPE VI, made over a 16-year period in a distressed Pittsburgh neighborhood called the Hill District. Specifically, we estimate the effects of the $468 million additional public-private investments that Hill District received compared to a demographically similar neighborhood on sale prices, rental prices, and crime. We find large and statistically significant impacts of the public-private investments on residential sales prices, commercial sales prices, and on rental prices, but only a marginally significant yet meaningful decline in non-violent arrests. For each additional $10 million of public-private investment, we find a 0.95 percent increase in residential sales prices, 2.7 percent increase in commercial sales prices, and 0.55 percent increase in rental prices. Because there was an accumulated difference over 16 years of $468 million in the amount of public-private investment across the two neighborhoods we examine, these percentage increases amount to large changes in real estate prices over that time. Commercial real estate investors and homeowners benefited the most, followed by residential landlords. Our analyses imply cities should anticipate the potential impacts of major neighborhood investment on low-income households, especially unsubsidized renters that most directly experience the brunt of rising rents.
- Published
- 2019
40. Food Insecurity is Associated with Objectively Measured Sleep Problems
- Author
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Wendy M. Troxel, Andrea S. Richardson, Jonathan M. Kurka, Lauren Hale, Tamara Dubowitz, Daniel J. Buysse, Ann C. Haas, Bonnie Ghosh-Dastidar, and Matthew P. Buman
- Subjects
Male ,Sleep Wake Disorders ,Polysomnography ,Neuroscience (miscellaneous) ,MEDLINE ,Medicine (miscellaneous) ,Article ,03 medical and health sciences ,0302 clinical medicine ,Sleep Initiation and Maintenance Disorders ,Environmental health ,Humans ,Medicine ,Sleep disorder ,business.industry ,food and beverages ,Regression analysis ,Middle Aged ,medicine.disease ,Sleep in non-human animals ,Food insecurity ,Food Insecurity ,030228 respiratory system ,Female ,Neurology (clinical) ,Psychology (miscellaneous) ,business ,030217 neurology & neurosurgery - Abstract
OBJECTIVE/ BACKGROUND: Food Insecurity (FI) can be a profound source of stress, which may increase the risk for sleep disturbance. This is the first study to examine the association between FI and objectively and subjectively measured sleep. PARTICIPANTS: The sample included 785 adults living in two low-income neighborhoods (mean age=56; 95% African American). OBJECTIVE: Our study is the first to examine the association between FI and multiple dimensions of sleep, assessed objectively and subjectively. METHODS: FI was measured using a 10-item survey that assesses conditions and behaviors that characterize households when they lack financial resources to meet basic food needs. Sleep duration, efficiency, wakefulness after sleep onset (WASO), and variability in sleep duration were measured via actigraphy. Sleep quality was assessed via sleep diary. Sleep outcomes were analyzed as a function of FI, adjusting for covariates. Psychological distress was tested as a potential mediator. RESULTS: Greater FI was associated with shorter actigraphy-assessed sleep duration (B=−2.44; SE=1.24; i.e., 24 minutes shorter for the most as compared to least insecure group), poorer sleep efficiency (B=−.27; SE=.13); p’s 9 hours; OR =1.19; CI: 1.01–1.39), compared to the recommended sleep duration of 7–9 hours. Psychological distress partially mediated the association between FI and subjective sleep quality. CONCLUSIONS: FI is an independent correlate of sleep disturbance. Findings demonstrate the importance of considering novel social determinants underlying sleep health disparities.
- Published
- 2019
41. Sleep myths: an expert-led study to identify false beliefs about sleep that impinge upon population sleep health practices
- Author
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Kristen L. Knutson, Girardin Jean-Louis, Lauren Hale, Shawn D. Youngstedt, Wendy M. Troxel, Daniel J. Buysse, Orfeu M. Buxton, Sanjay R. Patel, Rebecca Robbins, Charles A. Czeisler, and Michael A. Grandner
- Subjects
Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,education.field_of_study ,Population Health ,Public health ,Applied psychology ,Population ,Delphi method ,Population health ,Sleep medicine ,Focus group ,Article ,Likert scale ,Scientific evidence ,03 medical and health sciences ,Behavioral Neuroscience ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Sleep ,Psychology ,education ,030217 neurology & neurosurgery - Abstract
Introduction False beliefs about sleep can persist despite contradicting scientific evidence, potentially impairing population health. Identifying commonly held false beliefs lacking an evidence base (“myths”) can inform efforts to promote population sleep health. Method We compiled a list of potential myths using Internet searches of popular press and scientific literature. We used a Delphi process with sleep experts (n = 10) from the fields of sleep medicine and research. Selection and refinement of myths by sleep experts proceeded in 3 phases, including focus groups (Phase 1); email-based feedback to edit, add, or remove myths (Phase 2); and closed-ended questionnaires (Phase 3) where experts rated myths on 2 dimensions, falseness and public health significance, using 5-point Likert scale from 1 (“not at all”) to 5 (“extremely false”). Results The current study identified 20 sleep myths. Mean expert ratings of falseness ranged from 5.00 (SD = 0.00) for the statement “during sleep the brain is not active” to 2.50 (SD = 1.07) for the statement “sleeping in during the weekends is a good way to ensure you get adequate sleep.” Mean responses to public health significance ranged from 4.63 (SD = 0.74) for debunking the statement that “many adults need only 5 or less hours of sleep for general health” to 1.71 (SD = 0.49) for the statement that “remembering your dreams is a sign of a good night's sleep.” Conclusion The current study identified commonly held sleep myths that have a limited or questionable evidence base. Ratings provided by experts suggest areas that may benefit from public health education to correct myths and promote healthy sleep.
- Published
- 2019
42. Associations between young adult marijuana outcomes and availability of medical marijuana dispensaries and storefront signage
- Author
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Anthony Rodriguez, Joan S. Tucker, Regina A. Shih, Eric R. Pedersen, Elizabeth J. D'Amico, Wendy M. Troxel, Jordan P. Davis, Layla Parast, and Lisa Kraus
- Subjects
Male ,Adolescent ,030508 substance abuse ,Medicine (miscellaneous) ,Medical marijuana card ,Medical Marijuana ,California ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Marijuana use ,Advertising ,Residence Characteristics ,mental disorders ,Humans ,Medicine ,Marijuana Dispensaries ,030212 general & internal medicine ,Young adult ,business.industry ,Commerce ,Secondary data ,Consumer Behavior ,Confidence interval ,Frequent use ,Psychiatry and Mental health ,Signage ,Female ,Marijuana Use ,0305 other medical science ,business ,Demography - Abstract
Aims We investigated associations between the density of medical marijuana dispensaries (MMDs) around young adults' homes and marijuana use outcomes. Design Secondary data analysis. Setting Los Angeles County, CA, USA. Participants A total of 1887 participants aged 18-22 years, surveyed online in 2016-17. Measurements Outcomes were past-month marijuana use (number of days used, number of times each day), positive expectancies and perceived peer use. Density was measured as the total number of MMDs and number of MMDs with storefront signage indicative of marijuana sales, within 4 miles of respondents' homes. Findings Eighty-four per cent of respondents had 10 or more MMDs within 4 miles of their homes. Multiple linear regression analyses that adjusted for individual-level socio-demographic characteristics and neighborhood socio-economic status indicated that living near a higher number of MMDs was associated with greater number of days used in the past month [β = 0.025; 95% confidence interval (CI) = 0.001, 0.049; P = 0.04] and higher positive marijuana expectancies (β = 0.003; 95% CI = 0.001, 0.007; P = 0.04). Living near more MMDs with storefront signage had a four- to six-fold larger effect on number of times used per day and positive expectancies, respectively, compared with associations with the total MMD count. Adjusting for medical marijuana card ownership attenuated the association with number of days used in the past month and positive expectancies, and an unexpected association emerged between higher MMD density and fewer number of times used each day (β = -0.005; 95% CI = -0.009, -0.001; P = 0.03). Conclusions For young adults in Los Angeles County, living near more medical marijuana dispensaries (MMDs) is positively associated with more frequent use of marijuana within the past month and greater expectations of marijuana's positive benefits. MMDs with signage show stronger associations with number of times used each day and positive expectancies.
- Published
- 2019
43. Housing insecurity and sleep among welfare recipients in California
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Robert Bozick, Lynn A. Karoly, and Wendy M. Troxel
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Adult ,media_common.quotation_subject ,Social Welfare ,Sample (statistics) ,Payment ,Vulnerable Populations ,California ,Health equity ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Propensity score matching ,Housing ,Humans ,Self Report ,030212 general & internal medicine ,Neurology (clinical) ,Sleep (system call) ,Sleep ,Psychology ,Welfare ,Socioeconomic status ,030217 neurology & neurosurgery ,media_common ,Demography - Abstract
Study Objectives To estimate the effect of housing insecurity on sleep duration and sleep quality. Methods Using longitudinal data from a sample of 1,046 welfare recipients in the state of California followed from 2015–2016 through 2017–2018, we regressed self-reported measures of sleep duration and sleep quality recorded in 2017–2018 on experiences of housing insecurity in the prior year. We applied propensity score weights to attenuate potential bias from an array of observed covariates, including sleep duration and sleep quality measured prior to experiences with housing insecurity. Results Sample members who were unable to make their rent/mortgage payments slept on average 22 fewer minutes a night and had lower quality sleep than those who were able to make their rent/mortgage payments. Sample members who were forced to move because of an inability to make rent/mortgage payments slept on average 32 fewer minutes a night and had lower quality sleep than those who were not forced to move. Conclusions By compromising sleep health, housing insecurity represents a distinct form of stress in the lives of economically-disadvantaged adults, which could also contribute to other health disparities.
- Published
- 2021
44. Does investing in low-income urban neighborhoods improve sleep?
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Wendy M. Troxel, Bonnie Ghosh-Dastidar, Lauren Hale, Ann C. Haas, Daniel J. Buysse, Stephanie Brooks Holliday, Robin L. Beckman, Tamara Dubowitz, Andrea S. Richardson, Matthew P. Buman, and Rebecca L. Collins
- Subjects
Sleep, Health and Disease ,medicine.medical_specialty ,Natural experiment ,03 medical and health sciences ,0302 clinical medicine ,Residence Characteristics ,Physiology (medical) ,medicine ,Humans ,030212 general & internal medicine ,Social determinants of health ,Poverty ,Socioeconomic status ,Public health ,Health equity ,Black or African American ,Cross-Sectional Studies ,Cohort ,population characteristics ,Neurology (clinical) ,Sleep (system call) ,Sleep onset ,Sleep ,Psychology ,human activities ,030217 neurology & neurosurgery ,Demography - Abstract
Study Objectives Neighborhood disadvantage is associated with poor sleep, which may contribute to and exacerbate racial and socioeconomic health disparities. Most prior work has been cross-sectional and thus it has not been possible to estimate causal effects. Methods We leveraged a natural experiment opportunity in two low-income, predominantly African American Pittsburgh, PA neighborhoods, following a randomly selected cohort of households (n = 676) between 2013 and 2016. One of the neighborhoods received substantial public and private investments (housing, commercial) over the study period, while the other socio-demographically similar neighborhood received far fewer investments. Primary analyses used a difference-in-difference analysis based on neighborhood, to examine changes in actigraphy-assessed sleep duration, efficiency, and wakefulness after sleep onset (WASO), and self-reported sleep quality. Secondary analyses examined whether residents’ proximity to investments, regardless of neighborhood, was associated with changes in sleep outcomes. Results Resident sleep worsened over time in both neighborhoods with no significant differences among residents between the two neighborhoods. Secondary analyses, including covariate adjustment and propensity score weighting to improve comparability, indicated that regardless of neighborhood, those who lived in closer proximity to investments ( Conclusions While we did not observe sleep differences among residents between neighborhoods, living closer to a neighborhood investment was associated with better sleep outcomes. Findings have relevance for public health and policy efforts focused on investing in historically disinvested neighborhoods.
- Published
- 2021
45. The effects of caffeinated products on sleep and functioning in the military population: A focused review
- Author
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Brittany Taylor, Ninad S. Chaudhary, Wendy M. Troxel, Subhajit Chakravorty, and Michael A. Grandner
- Subjects
Male ,Active duty ,media_common.quotation_subject ,Clinical Biochemistry ,Population ,Toxicology ,Biochemistry ,Coffee ,Article ,03 medical and health sciences ,Behavioral Neuroscience ,0302 clinical medicine ,Cognition ,Environmental health ,Caffeine ,Sleep Initiation and Maintenance Disorders ,Surveys and Questionnaires ,Insomnia ,Medicine ,Energy Drinks ,Humans ,education ,Biological Psychiatry ,media_common ,Pharmacology ,education.field_of_study ,Clinical Trials as Topic ,business.industry ,Sleep in non-human animals ,030227 psychiatry ,Sleep deprivation ,Military personnel ,Military Personnel ,Physical Fitness ,Sleep Deprivation ,Female ,medicine.symptom ,business ,Sleep ,030217 neurology & neurosurgery ,Psychomotor Performance ,Vigilance (psychology) - Abstract
Military personnel rely on caffeinated products such as coffee or energy drinks (ED) to maintain a maximal level of vigilance and performance under sleep-deprived and combat situations. While chronic caffeine intake is associated with decreased sleep duration and non-restful sleep in the general population, these relationships are relatively unclear in the military personnel. We conducted a focused review of the effects of caffeinated products on sleep and the functioning of military personnel. We used a pre-specified search algorithm and identified 28 peer-reviewed articles published between January 1967 and July 2019 involving military personnel. We classified the findings from these studies into three categories. These categories included descriptive studies of caffeine use, studies evaluating the association between caffeinated products and sleep or functioning measures, and clinical trials assessing the effects of caffeinated products on functioning in sleep-deprived conditions. Most of the studies showed that military personnel used at least one caffeine-containing product per day during active duty and coffee was their primary source of caffeine. Their mean caffeine consumption varied from 212 to 285 mg/day, depending on the type of personnel and their deployment status. Those who were younger than 30 years of age preferred ED use. Caffeine use in increasing amounts was associated with decreased sleep duration and increased psychiatric symptoms. The consumption of caffeinated products during sleep deprivation improved their cognitive and behavioral outcomes and physical performance. Caffeine and energy drink consumption may maintain some aspects of performance stemming from insufficient sleep in deployed personnel, but excessive use may have adverse consequences.
- Published
- 2020
46. An Audit Tool for Longitudinal Assessment of the Health-Related Characteristics of Urban Neighborhoods: Implementation Methods and Reliability Results
- Author
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Andrea S. Richardson, Natalie Colabianchi, Tamara Dubowitz, Madhumita Ghosh-Dastidar, Gerald P. Hunter, Rebecca L. Collins, Jennifer Sloan, and Wendy M. Troxel
- Subjects
Built environment ,Longitudinal assessment ,Applied psychology ,030209 endocrinology & metabolism ,Sample (statistics) ,Audit ,Direct observation ,Neighborhood environment ,03 medical and health sciences ,Audit tool ,0302 clinical medicine ,Residence Characteristics ,Medicine ,Humans ,030212 general & internal medicine ,Poverty ,Reliability (statistics) ,Physical disorder ,business.industry ,Clinical study design ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,Reproducibility of Results ,lcsh:RA1-1270 ,Reliability ,Test (assessment) ,Cross-Sectional Studies ,Environment Design ,Biostatistics ,business ,Research Article - Abstract
Background Improving the neighborhood environment may help address chronic disease and mortality. To identify neighborhood features that are predictors of health, objective assessments of the environment are used. Multiple studies have reported on cross-sectional assessments of health-related neighborhood features using direct observation. As study designs expand to better understand causation and predictors of change, there is a need to test whether direct observation methods are adequate for longitudinal assessment. To our knowledge, this is the first study to report on the reliability of repeated measurements of the neighborhood environment, and their stability, over time. Methods The Pittsburgh Hill/Homewood Research on Neighborhood Change and Health (PHRESH) study conducted longitudinal assessments in two low-income, African American neighborhoods at three waves (years 2012, 2015, 2017). The PHRESH audit tool is a modification of earlier validated tools, with an emphasis on environment features relevant for physical activity, sleep, and obesogenic behaviors. Trained data-collector pairs conducted direct observations of a 25% sample of street segments in each neighborhood. At each wave, we audited a sub-sample of street segments twice and assessed reliability using percentage inter-observer agreement and krippendorf’s alpha statistics. Stability of these items was assessed as exhibiting moderate or high agreement at every time point. Results Across waves, a majority (81%) of the items consistently demonstrated moderate to high agreement except for items such as public/communal space, amount of shade, sidewalk features, number of traffic lanes, garden/flower bed/planter, art/statue/monument, amount of trash, and physical disorder. The list of items with poor agreement includes features that are easy to miss (e.g. flower bed/planter), hard to assess from outside (e.g. public/communal space), or may change quickly (e.g. amount of trash). Conclusion In this paper, we have described implementation methods, reliability results and lessons learned to inform future studies of change. We found the use of consistent methods allowed us to conduct reliable, replicable longitudinal assessments of the environment. Items that did not exhibit stability are less useful for detecting real change over time. Overall, the PHRESH direct observation tool is an effective and practical instrument to detect change in the neighborhood environment.
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- 2020
47. Longitudinal associations of sleep problems with alcohol and cannabis use from adolescence to emerging adulthood
- Author
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Wendy M. Troxel, Joan S. Tucker, Regina A. Shih, Lu Dong, Anthony Rodriguez, Elizabeth J. D'Amico, and Rachana Seelam
- Subjects
Adult ,Sleep Wake Disorders ,Adolescent ,Alcohol ,Bedtime ,03 medical and health sciences ,chemistry.chemical_compound ,Young Adult ,0302 clinical medicine ,Physiology (medical) ,Intervention (counseling) ,Insomnia ,Medicine ,Humans ,030212 general & internal medicine ,Longitudinal Studies ,Cannabis ,Jet Lag Syndrome ,business.industry ,Sleep in non-human animals ,Mental health ,chemistry ,Adolescent Behavior ,Sleep Across the Lifespan ,Neurology (clinical) ,medicine.symptom ,business ,Sleep ,030217 neurology & neurosurgery ,Demography ,Adolescent health - Abstract
Study Objectives This study examined longitudinal associations of sleep problems with alcohol and cannabis use across six annual waves of data from adolescence to emerging adulthood. Methods Participants were 3,265 youth from California (ages 16–22 across waves). At each wave, past-month alcohol use and cannabis use, mental health, and several dimensions of sleep health (i.e. social jetlag, bedtimes, time in bed, trouble sleeping) were assessed via questionnaire. Parallel process latent growth models examined the association between sleep and alcohol or cannabis use trajectories and the role of mental health in contributing to such trajectories. Results Smaller declines in social jetlag (r = 0.11, p = 0.04), increases in trouble sleeping (r = 0.18, p < 0.01), and later weekday (r = 0.16, p < 0.01) and weekend bedtimes (r = 0.25, p < 0.01) were associated with increases in likelihood of alcohol use over time. Declines in weekend TIB (r = −0.13, p = 0.03), as well as increases in weekday TIB (r = 0.11, p = 0.04) and later weekday (r = 0.18, p < 0.01) and weekend bedtime (r = 0.24, p < 0.01), were associated with increases in likelihood of cannabis use over time. Most associations remained significant after controlling for time-varying mental health symptoms. Conclusions Trajectories of sleep health were associated with trajectories of alcohol and cannabis use during late adolescence to emerging adulthood. Improving sleep is an important target for intervention efforts to reduce the risk of substance use during this critical developmental transition.
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- 2020
48. Understanding sleep facilitators, barriers, and cultural dimensions in Native American urban youth
- Author
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Carrie L. Johnson, Elizabeth J. D'Amico, Alina I. Palimaru, Wendy M. Troxel, Ryan Andrew Brown, and Daniel L. Dickerson
- Subjects
Male ,Adolescent ,Urban Population ,Population ,Psychological intervention ,Article ,Developmental psychology ,03 medical and health sciences ,Behavioral Neuroscience ,0302 clinical medicine ,Intervention (counseling) ,Humans ,Behavior management ,030212 general & internal medicine ,education ,Child ,Qualitative Research ,education.field_of_study ,Cultural Characteristics ,Stressor ,Alaskan Natives ,Sleep in non-human animals ,Female ,Psychology ,Sleep ,Psychosocial ,030217 neurology & neurosurgery ,Qualitative research - Abstract
Objectives American Indian/Alaska Native (AI/AN) youth are a high-risk group for sleep problems and associated chronic conditions. Urban AI/AN youth may face certain challenges, including specific psychosocial stressors (e.g., discrimination) and environmental factors (e.g., noise, light) that render them particularly vulnerable to poor sleep health. However, few studies have explored AI/AN adolescent sleep. To our knowledge, this is the first study to use systematic qualitative methods with AI/AN youth to explore their sleep environment and sleep behaviors. Design In-depth interviews with 26 youth. Setting Two urban areas in Central and Southern California. Participants Urban-dwelling AI/AN youth, age 12-16 years. Intervention N/A. Measurement N/A. Results We identified five main themes, each with subthemes: sleep patterns and desired sleep, sleep barriers inside the home, environmental factors, sleep facilitators, and cultural dimensions. Key concerns discussed were poor sleep hygiene, excessive use of electronics prior to bedtime, issues with temperature regulation, and noise both within and outside the home. Parents can be an important vehicle for messaging around sleep health and for behavior management. Participating adolescents also indicated differing levels of attachment to Native identity, suggesting that culturally-targeted sleep interventions should build in openness and flexibility to a range of identity starting points. Further, we identified cultural practices, such as sweat lodges and dreamcatchers, that could be incorporated in future sleep interventions for this population. Conclusion Findings increase our understanding of urban AI/AN youth's sleep environments and behaviors, thus potentially informing program development around sleep health for this vulnerable population.
- Published
- 2020
49. 1572-P: Neighborhood Investments and Cardiometabolic Health in Two Predominantly African-American Communities: A Natural Experiment Study
- Author
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Tiffany L. Gary-Webb, Timothy A. Bogart, Tamara Dubowitz, Madhumita Ghosh Dastidar, and Wendy M. Troxel
- Subjects
Natural experiment ,business.industry ,Endocrinology, Diabetes and Metabolism ,Clinical study design ,Health equity ,Interim ,Cohort ,Covariate ,Internal Medicine ,Medicine ,Residence ,Risk factor ,business ,Demography - Abstract
Background: Neighborhood disadvantage is a robust and independent risk factor for poor cardiometabolic health, however, causal relationships have been difficult to establish. We used a natural experiment design to examine neighborhood investment on cardiometabolic risk factors among a randomly selected cohort of residents from two, low-income, urban, and predominately African American matched neighborhoods. Methods: The sample included 532 participants (80% female; mean age=59 years; mean income=$21,073). During the study period (2016-2018), the intervention neighborhood received substantially more publicly-funded investments (housing and commercial investment) than a demographically matched comparison neighborhood. Difference-in-difference analyses tested for differential change between the neighborhoods in BMI, HbA1c, HDL-c, and SBP and DBP. Covariates included age, sex, income, education, presence of children in the home, length of residence in neighborhood, and BMI (for all outcomes except BMI). Results: Contrary to expectations, relative to the comparison neighborhood, we saw a net increase in DBP (β=3.00, SE=1.24; p =.02) and a marginally significant increase in SBP (β= 4.30, p = .07) in the intervention neighborhood. In contrast, for HbA1c and HDL-c, intervention neighborhood residents showed improvements in these outcomes, relative to the comparison neighborhood; however, the effects were non or marginally significant after covariate adjustment (p=.12 for HbA1c and p=0.06 for HDL-c). There were no significant changes in BMI. Conclusion: Our findings suggest that the potential cardiometabolic benefits of neighborhood revitalization may manifest over a longer period of follow-up, and that there may be some interim consequences for certain health outcomes, in the process of neighborhood change. These findings highlight the importance of examining root causes of health disparities and using robust study designs. Disclosure T. Gary-Webb: None. T. Dubowitz: None. T.A. Bogart: None. M. Ghosh Dastidar: None. W.M. Troxel: None. Funding National Heart, Lung, and Blood Institute (HL131531)
- Published
- 2020
50. Violent crime, police presence and poor sleep in two low-income urban predominantly Black American neighbourhoods
- Author
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Lauren Hale, Daniel J. Buysse, Tamara Dubowitz, Rebecca L. Collins, Andrea S. Richardson, Alvin Kristian Nugroho, Matthew P. Buman, Madhumita Ghosh-Dastidar, Wendy M. Troxel, Robin L. Beckman, Gerald P. Hunter, and Stephanie Brooks Holliday
- Subjects
Low income ,Adult ,Epidemiology ,Violent crime ,Article ,Residence Characteristics ,mental disorders ,Medicine ,Humans ,Poverty ,health care economics and organizations ,Perceived safety ,business.industry ,Public Health, Environmental and Occupational Health ,social sciences ,Health equity ,Police ,United States ,Poor sleep ,Survey data collection ,Crime ,Sleep onset ,business ,Sleep ,human activities ,Sleep duration ,Clinical psychology - Abstract
ObjectiveTo examine violent crime in relation to sleep and explore pathways, including psychological distress, safety perceptions and perceived police presence, that may account for associations.MethodsIn 2018, 515 predominantly Black American (94%) adults (Pittsburgh, Pennsylvania, USA) provided survey data: actigraphy-assessed sleep duration and wakefulness after sleep onset (WASO). We estimated pathways from violent crime (2016–2018) to sleep through psychological distress, perceptions of safety and perceived adequacy of police presence.ResultsWASO was most strongly associated with violent crimes that were within 1/10 mile of the participant’s home and within the month preceding the interview. Violent crimes were associated with lower perceived safety (β=−0.13 (0.03), pConclusionsWe demonstrated that more proximal and more recent violent crimes were associated with reduced perceived safety and worse WASO. Differential exposure to violent crime among Black Americans may contribute to health disparities by reducing residents’ perceived safety and sleep health.
- Published
- 2020
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