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Investigate racial and ethnic differences in infant sleep and examine associations with insurance status and parent-infant bedtime behavioral factors (PIBBF).Participants are part of the COVID-19 Mother Baby Outcomes (COMBO) Initiative, Columbia University. Data on infant sleep (night, day and overall sleep duration, night awakenings, latency, infant's sleep as a problem) were collected at 4 months postpartum. Regressions estimated associations between race/ethnicity, insurance status, PIBBF and infants' sleep.A total of 296 infants were eligible (34.4% non-Hispanic White [NHW], 10.1% Black/African American [B/AA], 55.4% Hispanic). B/AA and Hispanic mothers were more likely to have Medicaid, bed/room-share, and report later infant bedtime compared to NHW mothers. Infants of B/AA mothers had longer sleep latency compared to NHW. Infants of Hispanic mothers slept less at night (∼70 ± 12 minutes) and more during the day (∼41 ± 12 minutes) and Hispanic mothers were less likely to consider infants' sleep as a problem compared to NHW (odds ratio 0.4; 95% confidence interval: 0.2-0.7). After adjustment for insurance status and PIBBF, differences by race/ethnicity for night and day sleep duration and perception of infant's sleep as a problem persisted (∼32 ± 14 minutes, 35 ± 15 minutes, and odds ratio 0.4; 95% confidence interval: 0.2-0.8 respectively). Later bedtime was associated with less sleep at night (∼21 ± 4 minutes) and overall (∼17 ± 5 minutes), and longer latency. Infants who did not fall asleep independently had longer sleep latency, and co-sleeping infants had more night awakenings.Results show racial/ethnic differences in sleep in 4-month-old infants across sleep domains. The findings of our study suggest that PIBBF have an essential role in healthy infant sleep, but they may not be equitably experienced across racial/ethnic groups.

Obstructive sleep apnea (OSA), a sleep disordered breathing (SDB) disorder, affects at least 25 million adults in the United States and is associated with increased risk for hypertension, diabetes and cardiovascular disease. Racial/ethnic minorities have a disproportionate burden of OSA along with the health sequelae associated with this condition. Despite supporting evidence of racial/ethnic disparities, few studies have investigated SDB including OSA among minoritized racial/ethnic groups. In this scoping review of the literature, the authors summarize current findings related to racial/ethnic disparities in OSA, identified social and environmental determinants of health, treatment inequities, and promising evidence-based interventions and conclude with future research directions. Based on the scientific literature, minoritized groups had not only a high prevalence of OSA, which is largely undiagnosed and untreated, but also more severe OSA. Treatment adherence was also lower among minoritized racial/ethnic groups. Researchers have documented social determinants as drivers (e.g., neighborhood environment) of the disproportionate OSA burden among racial/ethnic minority children and adults. Lastly, there is evidence that culturally-tailored evidence-based interventions for OSA improve awareness, screening, and treatment adherence of OSA among racial/ethnic minorities; thus, providers and researchers should consider implementation of these social determinant of health informed interventions to reduce the burden of OSA.

In this Round Table Discussion, an international panel of experts discuss issues related to the use of technology in the delivery of cognitive behavioral therapy for insomnia (CBT-I), in order to increase its reach. Panelists were, in alphabetical order, Carmela Alcántara, PhD, an Associate Professor at Columbia University School of Social Work in New York, USA, Bei Bei, PhD., an Associate Professor at Monash University in Melbourne, Australia, Charles M. Morin, PhD., a Professor of Psychology at Laval University in Quebec City, Canada, and Annemieke A. van Straten, PhD., a Professor of Clinical Psychology at the Vrije Universiteit in Amsterdam, the Netherlands. The session was chaired by Rachel Manber, PhD., a Professor of Psychiatry and Behavioral Sciences at Stanford University, in Palo Alto, California, USA. In their introductions each panelist discussed the use of technology in their respective country. All indicated that the most common way technology is used in the treatment of insomnia is through the use of video calls (telemedicine) to deliver individual CBT-I, and that this is mostly covered by publicly funded health insurance programs such as Medicare, especially since the COVID-19 pandemic. There are also some fully automated insomnia treatment programs, but they’re often not covered by Medicare or other health insurance programs.

This review summarizes recent literature addressing the association of short sleep duration, shift work, and obstructive sleep apnea with hypertension risk, blood pressure (BP) levels, and 24-hour ambulatory BP. Observational studies demonstrate that subjectively assessed short sleep increases hypertension risk, though conflicting results are observed in studies of objectively assessed short sleep. Intervention studies demonstrate that mild and severe sleep restriction are associated with higher BP. Rotating and night shift work are associated with hypertension as shift work may exacerbate the detrimental impact of short sleep on BP. Further, studies demonstrate that shift work may increase nighttime BP and reduce BP control in patients with hypertension. Finally, moderate to severe obstructive sleep apnea is associated with hypertension, particularly resistant hypertension. Obstructive sleep apnea is also associated with abnormal 24-hour ambulatory BP profiles, including higher daytime and nighttime BP, nondipping BP, and a higher morning surge. Continuous positive airway pressure treatment may lower BP and improve BP dipping. In conclusion, efforts should be made to educate patients and health care providers about the importance of identifying and treating sleep disturbances for hypertension prevention and management. Empirically supported sleep health interventions represent a critical next step to advance this research area and establish causality.

ImportanceAssociations between prenatal SARS-CoV-2 exposure and neurodevelopmental outcomes have substantial public health relevance. A previous study found no association between prenatal SARS-CoV-2 infection and parent-reported infant neurodevelopmental outcomes, but standardized observational assessments are needed to confirm this finding.ObjectiveTo assess whether mild or asymptomatic maternal SARS-CoV-2 infection vs no infection during pregnancy is associated with infant neurodevelopmental differences at ages 5 to 11 months.Design, Setting, and ParticipantsThis cohort study included infants of mothers from a single-site prospective cross-sectional study (COVID-19 Mother Baby Outcomes [COMBO] Initiative) of mother-infant dyads and a multisite prospective cohort study (Epidemiology of Severe Acute Respiratory Syndrome Coronavirus 2 in Pregnancy and Infancy [ESPI]) of pregnant individuals. A subset of ESPI participants was subsequently enrolled in the ESPI COMBO substudy. Participants in the ongoing COMBO study were enrolled beginning on May 26, 2020; participants in the ESPI study were enrolled from May 7 to November 3, 2021; and participants in the ESPI COMBO substudy were enrolled from August 2020 to March 2021. For the current analysis, infant neurodevelopment was assessed between March 2021 and June 2022. A total of 407 infants born to 403 mothers were enrolled (204 from Columbia University Irving Medical Center in New York, New York; 167 from the University of Utah in Salt Lake City; and 36 from the University of Alabama in Birmingham). Mothers of unexposed infants were approached for participation based on similar infant gestational age at birth, date of birth, sex, and mode of delivery to exposed infants.ExposuresMaternal symptomatic or asymptomatic SARS-CoV-2 infection.Main Outcomes and MeasuresInfant neurodevelopment was assessed using the Developmental Assessment of Young Children, second edition (DAYC-2), adapted for telehealth assessment. The primary outcome was age-adjusted standard scores on 5 DAYC-2 subdomains: cognitive, gross motor, fine motor, expressive language, and receptive language.ResultsAmong 403 mothers, the mean (SD) maternal age at delivery was 32.1 (5.4) years; most mothers were of White race (240 [59.6%]) and non-Hispanic ethnicity (253 [62.8%]). Among 407 infants, 367 (90.2%) were born full term and 212 (52.1%) were male. Overall, 258 infants (63.4%) had no documented prenatal exposure to SARS-CoV-2 infection, 112 (27.5%) had confirmed prenatal exposure, and 37 (9.1%) had exposure before pregnancy or at an indeterminate time. In adjusted models, maternal SARS-CoV-2 infection during pregnancy was not associated with differences in cognitive (β = 0.31; 95% CI, −2.97 to 3.58), gross motor (β = 0.82; 95% CI, −1.34 to 2.99), fine motor (β = 0.36; 95% CI, −0.74 to 1.47), expressive language (β = −1.00; 95% CI, −4.02 to 2.02), or receptive language (β = 0.45; 95% CI, −2.15 to 3.04) DAYC-2 subdomain scores. Trimester of exposure and maternal symptom status were not associated with DAYC-2 subdomain scores.Conclusions and RelevanceIn this study, results of a novel telehealth-adapted observational neurodevelopmental assessment extended a previous finding of no association between prenatal exposure to maternal SARS-CoV-2 infection and infant neurodevelopment. Given the widespread and continued high prevalence of COVID-19, these data offer information that may be helpful for pregnant individuals who experience asymptomatic or mild SARS-CoV-2 infections.

Public health surveillance surveys provide key data from which the U.S. population health estimates are derived. We conducted a systematic review of the contemporary scientific literature on prevalent Latina/o child and adult health outcomes to determine the proportion of peer-reviewed articles derived from national or state U.S. public health surveillance surveys that disaggregated or stratified Latina/o population health estimates by social determinants and, therefore, provided within-Latino group comparisons. We searched biomedical electronic databases (Ovid MEDLINE, EMBASE, PsycINFO, JSTOR, Sociological Abstracts) for observational U.S. studies published between January 2006 and June 2016 and identified 573 full-text articles on Latina/o health. Of those, 175 articles further disaggregated the data along five categories of social determinants: sociodemographics (61.0%), socioeconomic status (18.5%), migration factors (11.7%), place-based factors (8.1%), and individual/interpersonal factors (1.9%). Three-fourths of the articles (77.7%) focused on adults, and the remaining focused on children (22.9%). The number of mean articles published per year was 15.9, with some slight variation over the 10-year period. While equivocal, the seemingly low percentage may stem from limitations in research design and data collection, as well as the lack of clear guidelines or a standardized set of survey items that reflect disaggregation categories most relevant to the Latina/o community. Our results suggest the need for programmatic initiatives to promote and standardize Latina/o health data disaggregation across the lifecourse and across the research process from design, data collection, and analysis, to reporting and publication. PROSPERO2016:CRD42016041879.

Emerging data science techniques of predictive analytics expand the quality and quantity of complex data relevant to human health and provide opportunities for understanding and control of conditions such as heart, lung, blood, and sleep disorders. To realize these opportunities, the information sources, the data science tools that use the information, and the application of resulting analytics to health and health care issues will require implementation research methods to define benefits, harms, reach, and sustainability; and to understand related resource utilization implications to inform policymakers. This JACC State-of-the-Art Review is based on a workshop convened by the National Heart, Lung, and Blood Institute to explore predictive analytics in the context of implementation science. It highlights precision medicine and precision public health as complementary and compelling applications of predictive analytics, and addresses future research and training endeavors that might further foster the application of predictive analytics in clinical medicine and public health.

BACKGROUND: The psychological factors underlying physical inactivity in vulnerable cardiac adult populations remain understudied. Anxiety sensitivity, a cognitive vulnerability defined as fear of the physical, cognitive, and social consequences of anxiety, may be an important modifiable determinant of physical inactivity. We examined the association of anxiety sensitivity, and each anxiety sensitivity subscale (physical, cognitive, and social concerns), with physical inactivity in adults with a history of myocardial infarction (MI). METHODS: Using cross-sectional data from a nationally representative survey of adults (n=1417) in the United States who reported a health professional diagnosis of MI, we used weighted logistic regression models to evaluate the association between anxiety sensitivity (overall, and each subscale) and physical inactivity (self-reported exercise 0-1 days/week), with adjustment for age, gender, race, education, number of MIs, and depression RESULTS: Overall, 34.3% reported physical inactivity. Anxiety sensitivity was associated with greater odds of physical inactivity (OR=1.01, 95%CI:1.00,1.02, p=.026). Of the subscales, only physical concerns were associated with physical inactivity (OR=1.02, 95%CI:1.01,1.04, p=.008) in the final model. High vs. low fear of shortness of breath was most consistently associated with physical inactivity (OR=1.49 95%CI:1.08,2.06, p

IMPORTANCE: Associations between in utero exposure to maternal SARS-CoV-2 infection and neurodevelopment are speculated, but currently unknown. OBJECTIVE: To examine the associations between maternal SARS-CoV-2 infection during pregnancy, being born during the COVID-19 pandemic regardless of maternal SARS-CoV-2 status, and neurodevelopment at age 6 months. DESIGN, SETTING, AND PARTICIPANTS: A cohort of infants exposed to maternal SARS-CoV-2 infection during pregnancy and unexposed controls was enrolled in the COVID-19 Mother Baby Outcomes Initiative at Columbia University Irving Medical Center in New York City. All women who delivered at Columbia University Irving Medical Center with a SARS-CoV-2 infection during pregnancy were approached. Women with unexposed infants were approached based on similar gestational age at birth, date of birth, sex, and mode of delivery. Neurodevelopment was assessed using the Ages & Stages Questionnaire, 3rd Edition (ASQ-3) at age 6 months. A historical cohort of infants born before the pandemic who had completed the 6-month ASQ-3 were included in secondary analyses. EXPOSURES: Maternal SARS-CoV-2 infection during pregnancy and birth during the COVID-19 pandemic. MAIN OUTCOMES AND MEASURES: Outcomes were scores on the 5 ASQ-3 subdomains, with the hypothesis that maternal SARS-CoV-2 infection during pregnancy would be associated with decrements in social and motor development at age 6 months. RESULTS: Of 1706 women approached, 596 enrolled; 385 women were invited to a 6-month assessment, of whom 272 (70.6%) completed the ASQ-3. Data were available for 255 infants enrolled in the COVID-19 Mother Baby Outcomes Initiative (114 in utero exposed, 141 unexposed to SARS-CoV-2; median maternal age at delivery, 32.0 [IQR, 19.0-45.0] years). Data were also available from a historical cohort of 62 infants born before the pandemic. In utero exposure to maternal SARS-CoV-2 infection was not associated with significant differences on any ASQ-3 subdomain, regardless of infection timing or severity. However, compared with the historical cohort, infants born during the pandemic had significantly lower scores on gross motor (mean difference, −5.63; 95% CI, −8.75 to −2.51; F(1,267) = 12.63; P

Despite a higher prevalence of cardiovascular disease (CVD) risk factors, Hispanic-Americans have lower rates of CVD-related and all-cause mortality, as well as higher life expectancy than non-Hispanic whites - a phenomenon known as the Hispanic health paradox. However, this survival benefit attenuates with increased acculturation to Western lifestyles, potentially due to adoption of unhealthy behaviors. Accordingly, we assessed whether Hispanic ethnicity and linguistic acculturation, as measured by English proficiency, were associated with nonadherence to cardiovascular medications. We enrolled patients presenting to an academic medical center emergency department with suspected acute coronary syndrome between May 2014 and November 2017. Ethnicity, native language, and English proficiency were self-reported. Cardiovascular medication adherence was assessed using an electronic pill bottle that recorded the date and time of each bottle opening. Generalized linear models with a logit link were used to examine the association of Hispanic ethnicity and English proficiency with daily cardiovascular medication adherence, adjusting for demographics, comorbidities, and dosing frequency of the electronically-monitored medication. Among 332 included patients, mean age was 61.68 ± 12.05 years, 43.07% were women, and 62.95% were Hispanic, of whom 80.38% were native Spanish-speakers. Overall, Hispanics had higher odds of medication adherence than non-Hispanics (adjusted OR 1.31, 95% CI 1.16-1.49, p < 0.001). However, among native Spanish-speaking Hispanics, greater English proficiency was associated with lower odds of medication adherence (adjusted OR 0.80 per 1-point increase in English proficiency, 95% CI 0.75-0.86, p < 0.001). Although Hispanics had better medication adherence than non-Hispanics overall, increased linguistic acculturation among native Spanish-speakers was associated with worse adherence behaviors.

Introduction Acculturation stress, a type of sociocultural stress, and insomnia have been consistently, positively associated among Latinx populations; however, the mechanisms of this association remain elusive. Models of insomnia suggest maladaptive coping strategies, such as brooding and alcohol use, may drive the relationship between stress and this disorder. Because acculturation stress has been positively associated with brooding and alcohol use, these coping strategies may explain the relationship between acculturation stress and insomnia among Latinxs. Additionally, gender differences in the use of these coping strategies and insomnia have been well documented. Thus, we examined the indirect effects of acculturation stress on insomnia through brooding and alcohol use among Latinxs and explored gender differences in these effects. Methods Separate bias-corrected boot-strap tests of mediation with case resampling (1000 replications) were conducted to examine the indirect effect of acculturation stress measured using the Hispanic Stress Inventory(HSI), on insomnia, measured with the Insomnia Severity Index(ISI), through brooding and alcohol use. These tests were conducted using cross-sectional survey data from healthy Latinx adults participating in the Latino Sleep and Health Study(n=187). Unadjusted models were the primary models. Progressive adjustments were made to account for age and socioeconomic status. Stratified analyses by gender were conducted to explore potential differences in the mediation models between Latinx women and men. Results Participants were Mage=37.43(SD=13.67), 64.17% were women, and 30.48% were of low socioeconomic status. Participants reported a mean HSI of 9.28(SD=9.51), brooding score of 9.44(SD=2.88), and ISI of 6.65(SD=5.51). In a typical week, participants consumed M=2.61 alcoholic beverages(SD=4.68). In primary models, the total and direct effects of acculturation stress on insomnia were significant, (b=0.04,95%CI:0.02-0.06; b=0.02,95%CI:0.004-0.04). The indirect effects of acculturation stress through brooding were also significant (b=0.02, 95%BCa CI:0.01-0.03). Among women, these indirect effects had larger coefficients than among men (b=0.02,95%BCa CI:0.01-0.04; b=0.01,95%BCa CI:0.004-0.04). Alcohol use was not a significant mediator in this relationship, (b=-0.001,95%BCa CI:-0.004-0.0002). Conclusion These findings suggest that psychological interventions targeting Latinxs should aim to reduce brooding as a coping strategy for acculturation stress to promote healthy sleep. Future studies should replicate these analyses in temporally ordered data to test the causal relationships among these variables. Support (If Any)

Objective/Design Cross-sectional study to examine the determinants of sleep health among postpartum women during the COVID-19 pandemic in New York City (NYC). Setting/Participants A subset of participants recruited as part of the COVID-19 Mother Baby Outcomes (COMBO) cohort at Columbia University (N = 62 non-Hispanic White, N = 17 African American, N = 107 Hispanic). Measurements Data on maternal sleep, COVID-19 infection during pregnancy, sociodemographic, behavioral, and psychological factors were collected via questionnaire at 4 months postpartum. Self-reported subjective sleep quality, latency, duration, efficiency, disturbances, and daytime dysfunction were examined as categorical variables (Pittsburgh Sleep Quality Index [PSQI]). Associations between sleep variables and COVID-19 status, time of the pandemic, sociodemographic, behavioral, and psychological factors were estimated via independent multivariable regressions. Results Mothers who delivered between May-December 2020, who delivered after the NYC COVID-19 peak, experienced worse sleep latency, disturbances and global sleep health compared to those who delivered March-April 2020, the peak of the pandemic. Maternal depression, stress and COVID-19-related post-traumatic stress were associated with all sleep domains except for sleep efficiency. Maternal perception of infant's sleep as a problem was associated with worse global PSQI score, subjective sleep quality, duration, and efficiency. Compared to non-Hispanic White, Hispanic mothers reported worse global PSQI scores, sleep latency, duration and efficiency, but less daytime dysfunction. Conclusions These findings provide crucial information about sociodemographic, behavioral, and psychological factors contributing to sleep health in the postpartum period.

The intrauterine environment strongly influences development. Neurodevelopmental effects of in utero exposure to maternal SARS-CoV-2 infection are widely speculated but currently unknown. The COVID-19 Mother Baby Outcomes (COMBO) initiative was established at Columbia University Irving Medical Center (CUIMC) in New York City to prospectively study the health and wellbeing of infants with and without in utero exposure to maternal SARS-CoV-2 infection. We report findings on 6-month neurodevelopmental outcomes using the parental-report Ages & Stages Questionnaire, 3rd Edition (ASQ-3), from 107 in utero exposed and 131 unexposed full-term infants born between March and December, 2020. We compare these infants to a historical cohort comprised of 62 infants born at CUIMC at least two months prior to the onset of the pandemic. In utero exposure to maternal SARS-CoV-2 infection was not associated with differences on any ASQ-3 subdomain regardless of infection timing or severity, however, infants born during the pandemic had significantly lower scores on gross motor, fine motor, and personal-social subdomains when compared to the historical cohort. Infants born to women who were in the first trimester of pregnancy during the peak of the pandemic in NYC had the lowest personal-social scores. Birth during the pandemic, but not maternal SARS-CoV-2 infection, was associated with differences in neurodevelopmental outcomes at 6-months. These early findings suggest significantly higher public health impact for the generation born during the COVID-19 pandemic than previously anticipated.

OBJECTIVE: Hospital readmission following acute coronary syndrome (ACS) is associated with worsened patient outcomes and financial burden. Short sleep duration is a risk factor for cardiovascular events, and may therefore represent a behavioral factor that increases risk of adverse post-hospitalization outcomes. This study examined whether short sleep duration in the month after hospital evaluation for ACS is associated with 6-month all-cause emergency department (ED) and hospital readmission. METHODS: The current analyses entail a secondary analysis of a larger prospective observational cohort study. Sleep duration during the month following hospital evaluation for ACS was assessed subjectively and dichotomized as short (

Sleep is a fundamental necessity of life. However, sleep health and sleep disorders are not equitably distributed across racial/ethnic groups. In fact, growing research consistently demonstrates that racial/ethnic minorities are more likely to experience, for instance, shorter sleep durations, less deep sleep, inconsistent sleep timing, and lower sleep continuity in comparison to Whites. However, racial/ethnic disparities in reports of sleepiness and sleep complaints are inconsistent. Racial/ethnic groups have significant heterogeneity, yet within-group analyses are limited. Among the few published within-group analyses, there are differences in sleep between non-US-born and US-born racial/ethnic groups, but the group with the more favorable sleep profile is consistent for non-US-born Latinos compared to US-born Latinos and Whites but unclear for other racial/ethnic minority groups. These sleep health disparities are a significant public health problem that should garner support for more observational, experimental, intervention, and policy/implementation research. In this review, we 1) summarize current evidence related to racial/ethnic disparities in sleep health and within-group differences, focusing on the sleep of the following racial/ethnic minority categories that are defined by the United States Office of Management and Budget as: American Indian/Alaska Native, Asian, African American/Black, Hispanic/Latino, and Native Hawaiian/Pacific Islander; 2) discuss measurement challenges related to investigating sleep health disparities; 3) discuss potential contributors to sleep health disparities; 4) present promising interventions to address sleep health disparities; and 5) discuss future research directions on intersectionality and sleep health.

We designed an infographic intervention to help clinicians provide health information to persons living with HIV. In this study, we assessed the extent to which our intervention may improve objectively and subjectively measured health outcomes (CD4 count, viral load, and engagement with clinician among others) when integrated into routine visits in the Dominican Republic. In this pretest-posttest study, we followed participants for 9 months at 3-month intervals. Physicians administered the intervention during participants' first 3 visits. Outcome measures, selected using a conceptual model, were assessed at 4 time points. We assessed changes in outcomes over time with general linear regressions and Wilcoxon Signed-Rank tests. Participants (N = 50) were mostly female (56%) and had been living with HIV for a mean of 6.3 years (SD = 6.1). All outcomes, except CD4 count, demonstrated statistically significant improvements by study end. This provides preliminary evidence our intervention may improve outcomes, but further testing is needed.Diseñamos una intervención infográfica para ayudar a los médicos brindar información médica a personas viviendo con el VIH. En este estudio, evaluamos en qué medida nuestra intervención puede mejorar los resultados de salud (conteo de CD4, carga viral, y compromiso con el médico entre otros), medidos de una manera objetiva y subjetiva, cuando se incorpora en las visitas médicas de rutina en la República Dominicana. En este estudio de prueba previo y posterior, seguimos los participantes durante 9 meses a intervalos de 3 meses. Los médicos administraron la intervención durante las primeras 3 visitas de los participantes. Seleccionamos las medidas de resultado utilizando un marco conceptual y las evaluamos en los 4 puntos de tiempo. Evaluamos cambios a lo largo del tiempo usando regresiones lineales generales y pruebas de asociación de Wilcoxon Signed-Rank. Los participantes (N = 50) fueron mayormente mujeres (56%) y habían estado viviendo con el VIH durante una media de 6,3 años (DE = 6,1). Todos los resultados, aparte del conteo de CD4, demostraron mejoras estadísticamente significativas al final del estudio. Esto proporciona evidencia preliminar de que nuestra intervención puede mejorar los resultados de la salud, pero se justifican pruebas adicionales.

Background Hypertension guidelines recommend screening and treatment for masked hypertension (MHT). Yet, few primary care providers (PCPs) screen for MHT, and little is known about PCP awareness, knowledge, and attitudes toward MHT. Methods Three focus groups involving 30 PCPs from 3 medical centers in New York were conducted. Focus group transcripts were analyzed using thematic content analysis. Results Awareness of MHT varied, and only 2 providers had diagnosed MHT. There was also low knowledge about the prevalence and impact of MHT. While some PCPs were receptive to MHT screening after learning about its significance, others viewed the current evidence as insufficient to change practice. Providers were discomforted by labeling patients with nonelevated office blood pressure (BP) as hypertensive and reluctant to add another screening test to their workload without stronger evidence. There was distrust in the accuracy of home BP monitoring to screen for MHT. There was more confidence in ambulatory BP monitoring (ABPM) for MHT screening, but ABPM was viewed as largely inaccessible. There was broad agreement with lifestyle changes for MHT. There were concerns that antihypertensive medication lacked evidence from randomized trials and could induce harmful side effects. Conclusions Limited PCP knowledge about MHT, concerns about the accuracy and accessibility of screening tests, overloaded PCPs, and insufficient evidence were major barriers to screening and treatment for MHT. Prior to broad uptake by PCPs, randomized trials demonstrating the net benefits of MHT screening and treatment may be needed, along with increased dissemination of knowledge about MHT and improved access to ABPM.

Background: Short sleep duration is a contributor to cardiovascular disease (CVD) events and mortality. Short sleep duration is associated with an increased risk of high clinic blood pressure (BP). BP measured outside the clinic using 24-h ambulatory blood pressure monitoring (ABPM) is a better predictor of an individual's CVD risk. We examined the association between objectively-assessed sleep duration and 24-h ambulatory blood pressure (ABP). Methods: A total of 893 working adults underwent sleep and ABPM. Participants were fitted with an ABPM device, and measures were taken at 28–30 min intervals. Objective sleep duration, and times of wakefulness and sleep during the 24-h ABPM period were derived from wrist-worn actigraphy. Linear regression, adjusted for age, sex, race/ethnicity, body mass index, smoking status, and diabetes were conducted on the relationship between sleep duration and the ABP measures. Results: Mean age of participants (final n = 729, 59.5% female, 11.9% Hispanic) was 45.2 ± 10.4 y. Mean actigraphy-derived sleep duration was 6.8 ± 1.2 h. Sleep duration

BACKGROUND: Exposure to childhood adversities (CA) is associated with sleep disturbances; however, evidence has largely been drawn from cross-sectional data and has not addressed the relationship across developmental stages. Also, most studies have primarily focused on non-Hispanic White cohorts with a dearth of longitudinal evidence about racial/ethnic minorities. We examined the longitudinal association between CA and sleep disturbances in Puerto Rican youth. METHOD: The Boricua Youth Study is a longitudinal study of Puerto Rican youth living in San Juan, Puerto Rico, and the South Bronx, NY (N = 2491). Among youth 5–9 and 10–16 years old, sleep disturbances were assessed through three yearly interviews. Lifetime exposure to CA included parental loss, child maltreatment, parental maladjustment, and exposure to violence. Weighted generalized linear mixed models examined the longitudinal association between CA and sleep disturbances in youth adjusting for sociodemographic and contextual covariates. RESULTS: The prevalence of sleep disturbances was similar in both age groups (ages 5–9 and 10–16). In multivariable mixed models, CA were associated with sleep disturbance across three Waves among 10–16-year-olds. For example, having 2–3 or ≥ 4 types of CA were related to a higher prevalence of trouble falling/staying asleep in models adjusting for social context, gender, welfare status, or mother’s education. No associations were observed among 5–9-year-olds. CONCLUSION: The results suggest that cumulative adversities in childhood may lead to sleep problems in adolescence. These findings highlight the utility of addressing CA during childhood to help reduce sleep-wake disorders throughout adolescence, a known risk factor for future mental and physical health problems.

Social determinants of health (SDOH) refer to the broad range of social, economic, political, and psychosocial factors that directly or indirectly shape health outcomes and contribute to health disparities. There is a growing and concerted effort to address SDOH worldwide. However, the application of SDOH to health behavior change intervention research is unknown. We reviewed the synthesis literature on health behavior change interventions targeting self-regulation to (a) describe the sociodemographic characteristics, (b) determine which types of social determinants were tested as moderators of health behavior change interventions, (c) evaluate the methodological quality of the meta-analytic evidence, and (d) discuss scientific gaps and opportunities. Thirty (45.4%) of 66 articles examined heterogeneity of treatment effects by SDOH. There was a lack of racial/ethnic, immigrant, sexual/gender minority, and lifecourse sample diversity. Overall, 73.5% of SDOH moderator analyses tested heterogeneity of treatment effects by gender, race/ethnicity, and intervention setting; none examined neighborhood factors. Methodological quality was negatively correlated with number of SDOH analyses. Most SDOH moderator analyses were atheoretical and indicated statistically non-significant differences. We provide an integrated SDOH and science of behavior change framework and discuss scientific opportunities for intervention research on health behavior change to improve health equity.

Background The US Preventive Services Task Force (USPSTF) recommends out-of-office blood pressure (BP) testing to exclude white coat hypertension prior to hypertension diagnosis. Despite improved availability and coverage of home and 24-h ambulatory BP monitoring (HBPM, ABPM), both are infrequently used to confirm diagnoses. We used the Behavior Change Wheel (BCW) framework, a multi-step process for mapping barriers to theory-informed behavior change techniques, to develop a multi-component implementation strategy for increasing out-of-office BP testing for hypertension diagnosis. Informed by geographically diverse provider focus groups (n = 63) exploring barriers to out-of-office testing and key informant interviews (n = 12), a multi-disciplinary team (medicine, psychology, nursing) used rigorous mixed methods to develop, refine, locally adapt, and finalize intervention components. The purpose of this report is to describe the protocol of the Effects of a Multi-faceted intervention on Blood pRessure Actions in the primary Care Environment (EMBRACE) trial, a cluster randomized control trial evaluating whether a theory-informed multi-component strategy increased out-of-office testing for hypertension diagnosis. Methods/design The EMBRACE Trial patient sample will include all adults ≥ 18 years of age with a newly elevated office BP (≥ 140/90 mmHg) at a scheduled visit with a primary care provider from a study clinic. All providers with scheduled visits with adult primary care patients at enrolled ACN primary care clinics were included. We determined that the most feasible, effective implementation strategy would include delivering education about out-of-office testing, demonstration/instruction on how to perform out-of-office HBPM and ABPM testing, feedback on completion rates of out-of-office testing, environmental prompts/cues via computerized clinical decision support (CDS) tool, and a culturally tailored, locally accessible ABPM testing service. We are currently comparing the effect of this locally adapted multi-component strategy with usual care on the change in the proportion of eligible patients who complete out-of-office BP testing in a 1:1 cluster randomized trial across 8 socioeconomically diverse clinics. Conclusions The EMBRACE trial is the first trial to test an implementation strategy for improving out-of-office testing for hypertension diagnosis. It will elucidate the degree to which targeting provider behavior via education, reminders, and decision support in addition to providing an ABPM testing service will improve referral to and completion of ABPM and HBPMs. Trial registration Clinicaltrials.gov, NCT03480217, Registered on 29 March 2018

We used a socioecological framework to conduct a systematic review on the state of science on the prevalence, risk, and protective factors of insomnia and sleep quality among Asian, Black, and Latinx immigrants in the United States. Of 482 eligible articles, 6.22% met inclusion criteria, and 1.87% included US immigrant only samples. Articles with immigrant only samples focused on Latinx immigrants (20%) and Asian immigrants (16.7%). None focused on Black immigrants. Most articles did not report the country of origin differences or effects by intersecting social identities. Individual-level factors such as depression were among the most widely documented risk factors for insomnia across socioecological levels and immigrant groups, followed by acculturation and migration-related factors, and macro-level factors (e.g., housing and neighborhood), which had mixed findings. Our results suggest the need to expand traditional treatment models for insomnia to include socioecological factors beyond the individual level, particularly for US immigrants.

Evidence of popular interest in the interrelationships between mind, body, and heart disease dates to Ancient Grecian times and paved the way for modern-day scientific inquiry into the relationships between psychological comorbidities in coronary heart disease. Although the systematic evidence has suggested an association of poor medical prognosis and lower quality of life among patients with coronary heart disease with comorbid psychological conditions, the mechanisms are less well understood. In this selective review article, the epidemiology, mechanisms, screening, and treatment recommendations for 4 common psychological conditions (depression, anxiety, stress, and insomnia) comorbid with coronary heart disease are presented. We focus on the grand challenges and unprecedented opportunities for research in this area considering the methodological and technological innovations of the 21st century. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

BACKGROUND Guidelines recommend that patients with newly elevated office blood pressure undergo ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) to rule-out white coat hypertension before being diagnosed with hypertension. We explored patients’ perspectives of the barriers and facilitators to undergoing ABPM or HBPM. METHODS Focus groups were conducted with twenty English- and Spanish-speaking individuals from underserved communities in New York City. Two researchers analyzed transcripts using a conventional content analysis to identify barriers and facilitators to participation in ABPM and HBPM. RESULTS Participants described favorable attitudes toward testing including readily understanding white coat hypertension, agreeing with the rationale for out-of-office testing, and believing that testing would benefit patients. Regarding ABPM, participants expressed concerns over the representativeness of the day the test was performed and the intrusiveness of the frequent readings. Regarding HBPM, participants expressed concerns over the validity of the monitoring method and the reliability of home blood pressure devices. For both tests, participants noted that out-of-pocket costs may deter patient participation and felt that patients would require detailed information about the test itself before deciding to participate. Participants overwhelmingly believed that out-of-office testing benefits outweighed testing barriers, were confident that they could successfully complete either testing if recommended by their provider, and described the rationale for their testing preference. CONCLUSIONS Participants identified dominant barriers and facilitators to ABPM and HBPM testing, articulated testing preferences, and believed that they could successfully complete out-of-office testing if recommended by their provider.

Introduction Sleep and mental health have a bidirectional relationship. During pregnancy, poor sleep health, depression and stress are common and have been associated with poor maternal and fetal outcomes. The COVID-19 pandemic has introduced additional physical and psychological risk factors, due to high mortality rate, and economic and social repercussions. This study examines whether prenatal maternal mental health clusters are associated with multiple dimensions of sleep during pregnancy in the context of the COVID-19 pandemic. Methods From June-December 2020, participants were recruited as part of the COVID-19 Mother Baby Outcomes (COMBO) Cohort at Columbia University (N=188; at recruitment gestational age: 32.2±8.2 weeks; age: 32±6.75 years; N=74 Hispanic, N=65 White non-Hispanic, N=27 Black/African American, N=22 other). Survey data on maternal depression (PHQ-9), perceived stress (PSS), Covid-related stress, and sleep health (PSQI) were collected. Using hierarchical clustering, we created maternal mental health clusters (MMHC). Regressions analyses were implemented to estimate the associations between multiple dimensions of sleep based on MMHC. Results \We derived three MMHC: Low-risk (no depression, no Covid-stress, low-moderate perceived stress), Covid-stress (no depression, moderate Covid-stress, low-moderate perceived stress) and high-risk (moderate depression, moderate Covid-stress, moderate to high perceived stress). Maternal age, gestational age, income, and race were not significantly different across clusters. The Covid-stress cluster compared to the low-risk cluster reported worse subjective sleep quality (ß=0.34±0.11, p=0.0025), longer sleep latency (ß=0.44±0.13,p Conclusion Our results indicate that the COVID-19 pandemic has affected mental health profiles during pregnancy, with evidence of a high-risk cluster presenting Covid-stress and depressive symptoms and a Covid-stress cluster presenting Covid-stress without depressive symptoms in a multi-ethnic sample of pregnant women. Both were associated with poorer sleep health outcomes compared to the low-risk cluster. These results have important implications for screening and treatment for the sleep health and obstetric communities during these unprecedented times. Support (if any)

Introduction While psychological stress is adversely linked to sleep, the bidirectional and temporal relationships between sleep and psychological stress in the context of daily life are largely understudied, particularly among Latinxs. We examined the bidirectional relationships between daily sleep duration, sleep quality, perceived stress, and negative mood in Latinx adults. Methods Between 2016-2019, healthy Latinxs (N=42), defined as those without any major physical or psychiatric morbidities, and free from polysomnography-assessed sleep disorders, were recruited from a community sample in New York. Participants naïve to study hypotheses completed 40 consecutive days of actigraphy and ecological momentary assessment of psychological stress and negative mood (depressed, anxious mood) using a 0 (not at all) to 10 (extremely) scale, contributing 1713 observations. Daily sleep duration was measured via wrist-actigraphy, and perceived daily sleep quality (1[very bad] to 4[very good]) was assessed via morning self-report. Sources of daily stress, including sociocultural stress, were collected once each evening. Multi-level modeling was used to examine within-person effects and temporal associations with adjustment for day of the week. Results Mean age=37.2 (SD=11.8), 69.1% women, 36.6% unemployed, 64.3% immigrant, and 38.1% Spanish-speaking. Non-specific stress (43%), work (28%), and family/relationship (21%) stress were the most common sources of daily stress. Discrimination and immigration stress were rarely reported as daily sources of stress (1.2%). Mean nightly sleep duration was 403.9 minutes (±81.3). Preliminary lagged linear mixed models indicated that a 60-minute increase in sleep duration during the night predicted a -.12 change in stress ratings (SE=.001,p Conclusion Overall, these results imply distinct associations of sleep with both anxiety and depressed mood. Longer sleep duration and improved perceived sleep quality were associated with subsequent decreased stress and anxiety. Increased depressed mood predicted worse sleep quality that night. Future research should identify the mechanisms of action for these differential associations. Support (if any)

Hispanics/Latinos face specific sociocultural stressors associated with their marginalized status in the United States. While stress is known to cause poor sleep, the differential effects of the specific stressors faced by Hispanics/Latinos have not been evaluated. Using cross-sectional data from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study, we conducted weighted generalized linear models to evaluate the associations of acculturation stress, ethnic discrimination, and chronic moderate/severe stress with self-reported sleep outcomes (insomnia symptoms, daytime sleepiness, sleep duration) in individual and aggregate models adjusted for site, socio-demographics, behavioral, and medical conditions. Participants included 5313 Hispanic/Latino adults; 43.5% ≥ age 45, 54.8% female, and 22.0% US-born. Chronic moderate/severe stress, ethnic discrimination, and acculturation stress were each positively associated with sleep. In the adjusted aggregate model, only chronic moderate/severe stress was associated with insomnia symptoms (exp(b) = 1.07 for each additional stressor, 95% CI = 1.05, 1.09). Both acculturation stress (exp(b) = 1.05 for each additional SD, 95% CI = 1.02, 1.10) and ethnic discrimination (exp(b) = 1.05 for each additional SD, 95% CI = 1.01, 1.08) were associated with daytime sleepiness. Each SD increase in ethnic discrimination related to a 16% and 13% increased prevalence of short (< 7 h) (RRR = 1.16, 95% CI = 1.02, 1.31) and long sleep duration (> 9 h) (RRR = 1.13, 95% CI = 1.00, 1.27), respectively. These associations were consistent across sex. Acculturation stress and ethnic discrimination are associated with poor sleep in Hispanics/Latinos. Future research should explore whether behavioral sleep interventions minimize the impact of sociocultural stressors on sleep., Highlights • Latina/os face unique stressors associated with their marginalized status in the USA. • We explored the association of sociocultural stressors with Latina/o sleep. • Acculturation stress and ethnic discrimination were associated with daytime sleepiness. • Only chronic psychosocial stress was associated with insomnia symptoms. • Ethnic discrimination was associated with both short and long sleep duration.

Although Blacks sleep between 37–75 minutes less per night than non-Hispanic Whites, research into what drives racial differences in sleep duration is limited. We examined the association of anxiety sensitivity, a cognitive vulnerability, and race (Blacks vs. White) with short sleep duration (

Objective Shared decision-making (SDM) is increasingly promoted in the primary care setting, but depressive symptoms, which are associated with cognitive changes, may influence decision-making preferences. We sought to assess whether elevated depressive symptoms are associated with decision-making preference in patients with comorbid chronic illness. Methods We enrolled 195 patients ≥ 18 years old with uncontrolled hypertension from two urban, academic primary care clinics. Depressive symptoms were assessed using the 8-item Patient Health Questionnaire. Clinician-directed decision-making preference was assessed according to the Control Preference Scale. The impact of depressive symptoms on decision-making preference was assessed using generalized linear mixed models adjusted for age, gender, race, ethnicity, education, Medicaid status, Charlson Comorbidity Index, partner status, and clustering within clinicians. Results The mean age was 64.2 years; 72% were women, 77% Hispanic, 38% Black, and 33% had elevated depressive symptoms. Overall, 35% of patients preferred clinician-directed decision-making, 19% mostly clinician-directed, 39% shared, and 7% some or little clinician-input. Patients with (vs. without) elevated depressive symptoms were more likely to prefer clinician-directed decision-making (46% versus 29%; p = 0.02; AOR 2.51, 95% CI 1.30–4.85, p = 0.005). Remitted depressive symptoms (vs. never depressed) were not associated with preference. Conclusions Elevated depressive symptoms are associated with preference for clinician-directed decision-making. We suggest that clinicians should be aware of this effect when incorporating preference into their communication styles and take an active role in eliciting patient values and exchanging information about treatment choice, all important components of shared decision-making, particularly when patients are depressed.

Introduction While sleep disturbances and depression often co-occur, these associations are understudied among Hispanics/Latinos. We examined the associations of sleep disturbances and sleep burden with depressive symptoms among Hispanic/Latino adults in the United States. Methods We used cross-sectional data from the Hispanic Community Health Study/Study of Latinos Sueño Ancillary study (2010-2013). The study enrolled 2072 adults (ages 18-64; 51.5% females) who completed one-week wrist-actigraphy and sleep questionnaires. Sleep burden was operationalized as the total count of sleep disturbances across six domains (duration, efficiency, midpoint, variability, insomnia, sleepiness). Depressive symptoms were assessed using the Center for Epidemiological Studies Depression scale (CESD-10). We used weighted survey linear regressions to evaluate the association of sleep disturbances and sleep burden with elevated depressive symptoms (CESD≥10) in individual models adjusted for age, gender, site, heritage, nativity, education, income, and employment. Sensitivity analyses further adjusted for behavioral health risk factors and apnea-hypopnea index. Results An estimated 28.3% had elevated depressive symptoms, 8.0% had short sleep duration (9 hours), 45.2% exhibited a later sleep midpoint (≥4:00AM), 38.4% had high sleep timing variability (upper third tertile for between day sleep midpoint), 15.3% had insomnia (ISI≥10), 17.3% had excessive daytime sleepiness (ESS ≥10), 21.5% had poor sleep efficiency ( Conclusion Multiple inter-related sleep disturbances, particularly those pertaining to sleep quality and timing, are associated with depression and may be targets for future interventions aimed at improving mood among Hispanics/Latinos. Support HL127307, HL098927, HL125748

Short duration of sleep, defined as sleeping ≤7 h per night, is associated with poor cardiovascular disease (CVD) outcomes, including mortality [(1,2)][1]. There are known racial disparities for CVD [(3)][2] and for sleep health [(4)][3]. However, racial disparities in the context of short sleep

STUDY OBJECTIVES: We examined the association of sociocultural stress severity (i.e. acculturation stress, ethnic discrimination) and chronic stress burden with multiple dimensions of sleep in a population-based sample of US Hispanics/Latinos. We also explored whether employment status modified stress-sleep associations. METHODS: We conducted survey linear regressions to test the cross-sectional association of sociocultural stress severity and stress burden with sleep dimensions using data collected between 2010 and 2013 from individuals who participated in both the Hispanic Community Health Study/Study of Latinos Sueño and Sociocultural Ancillary studies (N = 1192). RESULTS: Greater acculturation stress (B = 0.75, standard error [SE] = 0.26, p < .01) and chronic psychosocial stress burden (B = 1.04, SE = 0.18, p < .001) were associated with greater insomnia symptoms but were not associated with actigraphic measures of sleep. Ethnic discrimination was not associated with any of the sleep dimensions. The association of acculturation stress with insomnia severity was greater in unemployed (B = 2.06, SE = 0.34) compared to employed (B = 1.01, SE = 0.31) participants (p-interaction = .08). CONCLUSIONS: Acculturation stress severity and chronic stress burden are important and consistent correlates of insomnia, but not actigraphically measured sleep dimensions. If replicated, future research should test whether interventions targeting the resolution of sociocultural stress improve sleep quality in Hispanics/Latinos.

OBJECTIVE Adverse endothelial cell health, an early pathogenic process underlying atherosclerosis and cardiovascular disease, is evident in childhood and adolescence. Sleep duration, a modifiable cardiovascular health behavior, may be an important cardiovascular disease prevention target that may affect endothelial cell health. We examined the associations of longer sleep duration with endothelial cell injury among youth. METHODS In a multiethnic sample of 235 children (63.0% female, mean age = 13.9 years), we conducted multivariable linear regressions to test the cross-sectional association of sleep duration and circulating levels of endothelial cell-derived microparticles (EMPs), phenotypic for endothelial cell activation and apoptosis (CD62E+ EMPs, CD31+/CD42b- EMPs, and CD31+/Annexin V+ EMPs). Sleep duration and EMPs were both treated as continuous variables. Models were adjusted for age, sex, race, pubertal status, household economic resources, and waist circumference. RESULTS Overall, 69.2% had short sleep duration (

Introduction Studies have found positive associations between acculturation and self-reported sleep disturbances among Latinx adults, however whether acculturation-related factors influence treatment preferences for sleep disturbances remain underexplored. This study examines the relationship between language preference, an indicator of acculturation, and various types of sleep aid use among Latinx adults. Methods Using cross-sectional screener survey data from the LAtino Sleep and Health Study (N=739) of Latinx adults living in NYC, we conducted logistic regression analyses to examine the relationship between language preference and 3 types of sleep aid use (prescription, over-the-counter, and natural/herbal). Language preference was determined by whether the survey was completed in English or Spanish. Participants responded “Yes/No” to each type of sleep aid use. Primary regression models included adjustments for gender and age. Sensitivity analyses were conducted accounting for self-reported, physician-diagnosed sleep disorders. Results In unadjusted models, participants with Spanish-language preference were 2.38 (OR=2.38, 95%CI:1.30-4.36) and 1.80 (OR=1.80,95%CI:1.27-2.55) times more likely to report prescription and natural/herbal sleep aid use, respectively, compared to those with English-language preference. In primary models, language preference was not significantly associated with any type of sleep aid use. However, being below age 50 was associated with 68% and 44% decreased odds of reporting prescription and natural/herbal sleep aid use, respectively, when compared to those above age 50-79 (OR=0.32, 95%CI:0.16-0.64; OR=0.56,95%CI:0.38-0.84).Those who reported a sleep disorder were 6.35, 2.65, and 2.83 times more likely to report prescription, over-the-counter, and natural/herbal sleep aid use (OR=6.35, 95%CI:3.45-11.69; OR=2.65,95%CI:1.61-4.36; OR=2.83, 95%CI:1.85-4.37) compared to those without sleep disorder. Conclusion To our knowledge, this is the first study to examine language preference and sleep aid use in a Latinx sample. After adjusting for demographics, language was no longer significantly associated with prescription or over-the-counter sleep aid use. This change in significance may be due to differences in the age composition of the sample by language preference. Future studies in more balanced age samples should replicate these findings, and further unpack the determinants of prescription sleep aid use in Latinx adults with sleep disorders given the adverse side effects associated with prescription sleep aids. Support (if any)

Introduction Greater perceived neighborhood safety (PNS) has been linked to better sleep quality and longer sleep duration. There is also evidence that past exposure to traumatic events may be associated with lower perceived personal safety and poor mental health. Yet, the moderating effects of lifetime trauma exposure on the association between PNS and sleep (duration & latency), has not been assessed. Methods We used cross-sectional data from 190 healthy NYC Latino adults. Lifetime trauma exposure was measured using the Life Events Checklist [LEC] (a count of traumatic events that happened to or were witnessed). In the first set of models, we regressed self-reported sleep duration in minutes (continuous), on PNS (safe vs. not safe), a single item scale, with three covariates (i.e. age, gender, education). In the second set, self-reported sleep latency in minutes, replaced sleep duration. To test for moderation, interaction terms—LEC x PNS—were added to covariate-adjusted models. In sensitivity analyses, regression models were re-run with adjustment for PTSD symptoms, and with short sleep duration ( Results On average, participants were 37.9 years old (SE= 1.02), 65.8% female, 59.5% foreign-born, and 33.2% completed < Bachelor’s degree. Overall, 43.68% slept 1 traumatic event in their lifetime. In adjusted models, each traumatic event (b= -2.95, SE = 1.34, p=0.03) was negatively associated with sleep duration. When PTSD symptoms was added, trauma was no longer statistically significant (b=-1.08, SE=1.02, p=0.18). However, each traumatic event exposure was associated with a 10% higher odds of short sleep duration (OR= 1.10, CI=1.02, 1.15), and this association remained significant with adjustment for PTSD symptoms. No interaction terms were significant. In models for sleep latency, there were no statistically significant main effects for LEC or interaction terms. Conclusion We found a dose response in the negative association between lifetime exposure to trauma and sleep duration, but not sleep latency. Trauma history did not moderate the association between PNS and sleep. These results suggest that short sleep duration may be particularly sensitive to lifetime exposure to trauma independent of neighborhood safety. Future studies should replicate these results in population-based samples. Support (if any)

Introduction Although caregiving is associated with shorter sleep durations and worse sleep quality, particularly among employed individuals, these studies have mostly examined household (i.e., child, adult) and domestic caregiving among majority non-Latinx White samples. Sending remittances, a form of transnational caregiving whereby financial support is provided to relatives in one’s country of origin, is associated with positive mental health among Latinxs, yet its association with sleep remains unexamined. We examined the association of household and transnational caregiving with sleep duration and quality, and explored the moderating effects of employment status on these relationships. Methods Using cross-sectional data of healthy Latinx adults in New York City (N=188), we conducted separate age and gender-adjusted linear regressions or logistic regressions to examine the association of caregiving and sleep duration, and poor sleep quality, respectively. Sleep duration (continuous) and sleep quality (fairly/very poor) were measured using two items from the PSQI. Household caregiving was defined as caregiving for children or adults in the household. Transnational caregiving was operationalized as sending remittances. Moderation was tested using employment status*caregiving cross-products in adjusted models. Results Participants were Mage=37.61(SD=14.07), 71.3% employed, 66.5% female, and 59.6% immigrants. Overall, 14.9% were household caregivers and 28.72% sent remittances. Household caregiving was not significantly associated with sleep duration or quality. Those who sent remittances reported on average sleeping 27.63 minutes less than non-remitters (b=-27.63,SE=13.93,p Conclusion Transnational caregivers were more likely to report shorter sleep duration and poorer sleep quality than their counterparts, and this was only observed among employed vs. unemployed Latinxs. Household caregiving was not significantly associated with sleep. Employed transnational caregivers may have multiple jobs that further constrain opportunities for longer and high-quality sleep. Future studies should examine potential upstream factors (e.g., working conditions) that may limit employed, transnational caregivers’ ability to obtain adequate sleep. Support (if any)

Psychological interventions for sleep-wake disorders have medium-to-large effect sizes, however whether behavioral randomized controlled trials (RCTs) targeted underserved populations or addressed contextual and cultural factors is unknown. We conducted a systematic review to: (a) examine sociodemographic characteristics of behavioral RCTs for prevalent sleep-wake disorders and sleep disturbances that targeted undeserved adults, (b) identify types of cultural adaptations (surface-level, deep-level), and (c) describe intervention effectiveness on primary sleep outcomes. Overall, 6.97% of RCTs (56 studies) targeted underserved groups (veterans, women, racial/ethnic minorities, low socioeconomic status, disability status); 64.29% made surface-level and/or deep-level cultural adaptations. There was a lack of racial/ethnic, socioeconomic, sexual orientation, and linguistic diversity. Most cultural adaptations were made to behavioral therapies, and cognitive behavioral therapy for insomnia (CBT-I). Surface-level cultural adaptations to the delivery modality and setting were most common. Deep-level cultural adaptations of the content and core intervention components were also typical. Intervention effectiveness varied by type of adapted intervention and participant population. RCTs of adapted CBT-I interventions among participants with a definite sleep disorder or sleep disturbance showed consistent significant reductions in adverse sleep outcomes versus control. These findings have important implications for the use of cultural adaptations to address behavioral sleep medicine disparities.