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Disparities in adolescent sleep health by sex and ethnoracial group.

ABSTRACT: Improving adolescent sleep health is a national priority for ameliorating health and wellbeing (Healthy People 2020), as the majority of adolescents do not get the minimum recommended amount of 8 h of sleep per night. Prior research has identified sex and ethnoracial disparities in adolescent sleep but has been limited by data availability. National studies have collected reported sleep data, while objective sleep data has been available in community samples only. Using new data from adolescents in the Fragile Families and Child Wellbeing Study, a population-based birth cohort study of children born 1998-2000, we are able to characterize sex and ethnoracial disparities in sleep health in the first national sample of actigraphy-assessed sleep health among adolescents. In cross-sectional analyses, we used linear and logistic regression models to assess sex and ethnoracial disparities in weekday sleep duration, timing, and quality measured using actigraphy collected from 738 adolescents at approximately age 15. We identified sex and ethnoracial group differences in weekday and weekend adolescent sleep duration, with larger disparities on weekends than weekdays. Male adolescents had 27-min shorter nightly sleep durations than females on weeknights. Non-Hispanic black adolescents had 32-min shorter nightly sleep durations than non-Hispanic whites on weekdays and 41-min shorter nightly sleep durations on weekends. While sex disparities persisted after accounting for naps, black-white differences were attenuated by napping such that there was no statistically significant black-white disparity in 24-h sleep on either weekdays or weekends. We did not identify disparities in sleep timing or quality. Future research should investigate the pathways through which these disparities arise, including behavioral and contextual mechanisms.

SUBMITTER: James S

PROVIDER: S-EPMC7191202 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Disparities in adolescent sleep health by sex and ethnoracial group.

James Sarah S Chang Anne-Marie AM Buxton Orfeu M OM Hale Lauren L

SSM - population health 20200409

Improving adolescent sleep health is a national priority for ameliorating health and wellbeing (Healthy People 2020), as the majority of adolescents do not get the minimum recommended amount of 8 h of sleep per night. Prior research has identified sex and ethnoracial disparities in adolescent sleep but has been limited by data availability. National studies have collected reported sleep data, while objective sleep data has been available in community samples only. Using new data from adolescents ...[more]

PMID: 32373706

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Project description:ImportanceUnderstanding how structural racism is associated with adolescent mental health is critical to advance health equity.ObjectiveTo assess associations between neighborhood privilege, measured by the Index of Concentration at the Extremes (ICE) and adolescent depressive symptoms, suicidality, and related racial and ethnic disparities.Design, setting, and participantsThis was a retrospective cohort study using electronic health records of adolescents aged 12 to 16 years who attended well-teen visits between 2017 and 2021. Kaiser Permanente Northern California is an integrated health care delivery system serving 4.6 million members. The cohort included 34 252 individuals born singleton at an affiliated facility from January 1, 2005, to December 31, 2009, and who had completed at least 1 mental health screener during a well-teen visit by November 23, 2021.ExposuresAmerican Community Survey 2016 to 2021 5-year estimates were used to calculate ICE scores for adolescents' residential census tract at ages 10 to 11. Three ICE measures were used as proxies of structural racism: racial privilege (ICE-race and ethnicity; hereinafter ICE-race), economic privilege (ICE-income), and combined economic and racial privilege (ICE-income plus race and ethnicity; herinafter ICE-income plus race). ICE scores were categorized into quintiles based on California statewide distributions.Main outcomes and measuresDepressive symptoms and suicidality were assessed through self-report screeners during well-teen visits. Depressive symptoms were considered to be present if patients had a score on the Patient Health Questionnaire-2 of 3 or higher (the tool uses a Likert scale to determine the frequency [0 = not at all; 3 = nearly every day] that they had depressed mood and lack of pleasure in usual activities in the past 2 weeks; responses were summed and dichotomized).ResultsAnalyses included 34 252 adolescents (12-16 years of age; mean [SD] age, 13.7 [0.8] years; 17 557 [51.3%] male, 7284 [21.3%] Asian or Pacific Islander, 2587 [7.6%] Black], 9061 [26.5%] Hispanic, 75 [0.2%] American Indian or Indigenous, 12 176 [35.5%] White, and 3069 [9%] other or unknown). Risks of depressive symptoms and suicidality generally increased with each level of declining neighborhood privilege. Adjusted risk ratios comparing adolescents from neighborhoods with the least to most racial and economic privilege were 1.37 (95% CI, 1.20-1.55) for depressive symptoms and 1.59 (95% CI, 1.23-2.05) for suicidality. Racial disparities between Black and White youth and Hispanic and White youth decreased after adjusting for each ICE measure, and became nonsignificant in models adjusting for ICE-race and ICE-income plus race.Conclusions and relevanceIn this cohort study, lower neighborhood privilege was associated with greater risks of adolescent depressive symptoms and suicidality. Furthermore, adjusting for neighborhood privilege reduced mental health disparities affecting Black and Hispanic adolescents. These findings suggest that efforts to promote equity in adolescent mental health should extend beyond the clinical setting and consider the inequitable neighborhood contexts that are shaped by structural racism.

Dataset Information

Disparities in adolescent sleep health by sex and ethnoracial group.

Publications

Disparities in adolescent sleep health by sex and ethnoracial group.

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