Employment status and the association of sociocultural stress with sleep in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Abstract

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.

<p>Are sleep patterns influenced by race/ethnicity – a marker of relative advantage or disadvantage? Evidence to date</p>

“…Such practices likely manifest into health disparities because of disadvantaged groups having less access to health promoting goods and services and greater exposure to health-damaging physical and social environments. More specific to sleep health disparities, there is evidence (albeit limited) that suggests psychosocial stressors, neighborhood context (physical and social), urban/inner city living, SES, access to and utilization of health care, and acculturation contribute to poor sleep health among racial/ethnic minorities as well as to racial/ethnic disparities in a host of health outcomes 18,28,65,75–81. Indeed, in race-stratified models, the associations between the neighborhood environment and short sleep (eg, <7 hours) are evident among only Black adults,78,80 illustrating the importance of the environment to sleep in this population.…”

“…For example, Hicken et al29 suggested that racism-related vigilance – the anticipation of experiencing racism – may be a unique source of chronic stress that contributes to the higher prevalence of sleep difficulty among Blacks 29. Similarly, in related work with Hispanics/Latinos, Alcantara et al80 2019 found that acculturation stress – the distress associated with integrating and adapting to the US mainland culture – was a unique contributor to insomnia symptoms beyond chronic stress, sociodemographic factors, and health risk behaviors 81. However, as previously discussed, self-reported sleep difficulties are often underreported among racial/ethnic minorities.…”

Crosswalking the Patient-Reported Outcomes Measurement Information System Physical Function, Pain Interference, and Pain Intensity Scores to the Roland-Morris Disability Questionnaire and the Oswestry Disability Index

“…acculturation stress among those who were unemployed relative to their employed counterparts [58]. This suggests sociocultural impact on sleep among racial/ethnic minority groups and that employment may be moderating this process.…”

Sleepless in COVID-19: racial disparities during the pandemic as a consequence of structural inequity

“…Beyond interpersonal discrimination, there are systemic social and structural inequities that may further account for racial/ethnic disparities in sleep health and insomnia. For example, acculturation stress and chronic stress are associated with greater insomnia symptom severity in Latinx/Hispanic adults [ 27 , 28 ]. Furthermore, associations between insomnia and race/ethnicity are often attenuated or eclipsed by associations between insomnia symptoms and socioeconomic factors downstream from structural discrimination (e.g.…”

“…employment status, education, food security, night work, noisy neighborhood) or health indicators (e.g. body mass index, physical activity, health problems) [ 27 , 31–36 ]. Disparities in stress exposure, economic prosperity, and access to health care are also probable explanatory factors for racial disparities that would be exacerbated due to the COVID-19 pandemic, which together can then potentiate worse insomnia symptoms.…”