Neighborhood Food Environment Associated with Cardiometabolic Health among Predominately Low-income, Urban, Black Women.

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.

Does investing in low-income urban neighborhoods improve sleep?

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 (<0.1 mile) were significantly less likely to experience decreases in sleep duration, efficiency, and quality, or increases in WASO, compared to those who lived farther away. 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.

Neighborhood disadvantage is associated with actigraphy-assessed sleep continuity and short sleep duration.

Study Objectives: Neighborhood disadvantage has been linked to poor sleep. However, the extant research has primarily focused on self-reported assessments of sleep and neighborhood characteristics. The current study examines the association between objective and perceived neighborhood characteristics and actigraphy-assessed sleep duration, efficiency, and wakefulness after sleep onset (WASO) in an urban sample of African American adults. Methods: We examined data from predominantly African American adults (n = 788, mean age 55 years; 77% female) living in two low-income neighborhoods. Perceived neighborhood characteristics included safety, social cohesion, and satisfaction with one's neighborhood as a place to live. Objective neighborhood conditions included walkability, disorder, street lighting, and crime levels. Sleep duration, efficiency, and WASO were measured via 7 days of wrist-worn actigraphy. Analyses estimated each of the sleep outcomes as a function of perceived and objective neighborhood characteristics. Individual-level sociodemographics, body mass index, and psychological distress were included as covariates. Results: Greater perceived safety was associated with higher sleep efficiency and shorter WASO. Greater neighborhood disorder and street lighting were associated with poorer sleep efficiency and longer WASO and greater likelihood of short sleep duration (<7 versus 7-9 hr as referent). Higher levels of crime were associated with poorer sleep efficiency and longer WASO, but these associations were only evident in one of the neighborhoods. Conclusions: Both how residents perceive their neighborhood and their exposure to objectively measured neighborhood disorder, lighting, and crime have implications for sleep continuity. These findings suggest that neighborhood conditions may contribute to disparities in sleep health.

Sleep-Wake Concordance in Couples Is Inversely Associated With Cardiovascular Disease Risk Markers.

Aim: To determine whether interdependence in couples' sleep (sleep-wake concordance i.e., whether couples are awake or asleep at the same time throughout the night) is associated with two markers of cardiovascular disease (CVD) risk, ambulatory blood pressure (BP) and systemic inflammation. Methods: This community-based study is a cross-sectional analysis of 46 adult couples, aged 18-45 years, without known sleep disorders. Percent sleep-wake concordance, the independent variable, was calculated for each individual using actigraphy. Ambulatory BP monitors measured BP across 48 h. Dependent variables included mean sleep systolic BP (SBP) and diastolic BP (DBP), mean wake SBP and DBP, sleep-wake SBP and DBP ratios, and C-reactive protein (CRP). Mixed models were used and were adjusted for age, sex, education, race, and body mass index. Results: Higher sleep-wake concordance was associated with lower sleep SBP (b = -.35, SE = .01) and DBP (b = -.22, SE = .10) and lower wake SBP (b = -.26, SE = .12; all p values < .05). Results were moderated by sex; for women, high concordance was associated with lower BP. Men and women with higher sleep-wake concordance also had lower CRP values (b = -.15, SE = .03, p < .05). Sleep-wake concordance was not associated with wake DBP or sleep/wake BP ratios. Significant findings remained after controlling for individual sleep quality, duration, and wake after sleep onset. Conclusions: Sleep-wake concordance was associated with sleep BP, and this association was stronger for women. Higher sleep-wake concordance was associated with lower systemic inflammation for men and women. Sleep-wake concordance may be a novel mechanism by which marital relationships are associated with long-term CVD outcomes.

Chronic Stress is Prospectively Associated with Sleep in Midlife Women: The SWAN Sleep Study.

STUDY OBJECTIVES: Evaluate whether levels of upsetting life events measured over a 9-y period prospectively predict subjective and objective sleep outcomes in midlife women. DESIGN: Prospective cohort study. SETTING: Four sites across the United States. PARTICIPANTS: 330 women (46-57 y of age) enrolled in the Study of Women's Health Across the Nation (SWAN) Sleep Study. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Upsetting life events were assessed annually for up to 9 y. Trajectory analysis applied to life events data quantitatively identified three distinct chronic stress groups: low stress, moderate stress, and high stress. Sleep was assessed by self-report and in-home polysomnography (PSG) during the ninth year of the study. Multivariate analyses tested the prospective association between chronic stress group and sleep, adjusting for race, baseline sleep complaints, marital status, body mass index, symptoms of depression, and acute life events at the time of the Sleep Study. Women characterized by high chronic stress had lower subjective sleep quality, were more likely to report insomnia, and exhibited increased PSG-assessed wake after sleep onset (WASO) relative to women with low to moderate chronic stress profiles. The effect of chronic stress group on WASO persisted in the subsample of participants without baseline sleep complaints. CONCLUSIONS: Chronic stress is prospectively associated with sleep disturbance in midlife women, even after adjusting for acute stressors at the time of the sleep study and other factors known to disrupt sleep. These results are consistent with current models of stress that emphasize the cumulative effect of stressors on health over time.

Sleep Concordance in Couples is Associated with Relationship Characteristics.

STUDY OBJECTIVES: Coregulation of biological systems is a defining feature of normative attachment in close adult relationships. Sleep is a shared, intimate biological process between couples; however, sleep is usually examined at the individual level. We examined minute-by-minute concordance in couples' actigraphy-defined sleep-wake patterns, and how attachment style and marital satisfaction relate to concordance. DESIGN: Couples completed measures of avoidant and anxious attachment styles and relationship functioning and wore wrist actigraphs for 10 days. Minute-by-minute concordance of sleep and wake (i.e., the percentage of epochs in which both partners were asleep, or both were awake) was calculated for each sleep period. Mixed modeling was used to account for measurement occasions across time. RESULTS: Percent concordance ranged from 53-88% and was not associated with couples' sleep quality or circadian preference. For wives, neither anxious nor avoidant attachment was associated with sleep-wake concordance. For husbands, anxious attachment style was associated with higher concordance, but was moderated by wives' marital satisfaction. High marital satisfaction in wives was associated with higher concordance, regardless of husbands' attachment style. In couples in which wives reported low satisfaction, concordance was higher when husbands had an anxious attachment style. Avoidant attachment style in husbands was not related to concordance. CONCLUSIONS: Sleep concordance provides a unique measure of couples' cosleep and varies depending on attachment style and relationship satisfaction.

Predictors of treatment response to brief behavioral treatment of insomnia (BBTI) in older adults.

STUDY OBJECTIVES: The extant literature on predictors of treatment response to behavioral treatments for insomnia is equivocal and limited in scope. The current study examined demographic, clinical, and sleep characteristics as predictors of clinically significant treatment response to brief behavioral treatment of insomnia (BBTI) in older adults with insomnia. METHODS: Thirty-nine older adults with insomnia (67% females, mean age: 72.54 years) were randomized to BBTI treatment. Treatment outcomes were defined according to 2 criteria: (1) "response," defined as change in Pittsburgh Sleep Quality Index (PSQI) score ≥ 3 points or increase in sleep diary sleep efficiency ≥ 10%); or (2) remission, defined as absence of a clinical diagnosis of insomnia according to standard diagnostic criteria. Logistic regression examined whether baseline demographic, clinical, or sleep characteristics predicted treatment outcomes at 1 month follow-up. RESULTS: Demographic variables did not predict treatment outcomes for either criterion. Higher anxiety, depression, poorer sleep quality, and longer polysomnography (PSG)-assessed sleep latency predicted greater likelihood of response at follow-up (p < 0.05). Longer sleep duration at baseline (measured by sleep diary and PSG) predicted greater likelihood of the remission at follow-up (p < 0.05). CONCLUSION: Patients with insomnia who have greater distress at baseline or prolonged sleep latency are more likely to show positive response to BBTI. In contrast, short sleepers at baseline are less likely to have resolution of insomnia diagnosis following BBTI, perhaps due to the sleep restriction component of the treatment. Identifying the characteristics that predict positive BBTI treatment outcomes can facilitate personalized behavioral treatments to improve outcomes.