Perceived neighborhood quality, sleep quality, and health status: Evidence from the Survey of the Health of Wisconsin

Abstract

Why does living in a disadvantaged neighborhood predict poorer mental and physical health? Recent research focusing on the Southwestern United States suggests that disadvantaged neighborhoods favor poor health, in part, because they undermine sleep quality. Building on previous research, we test whether this process extends to the Midwestern United States. Specifically, we use cross-sectional data from the Survey of the Health of Wisconsin (SHOW), a statewide probability sample of Wisconsin adults, to examine whether associations among perceived neighborhood quality (e.g., perceptions of crime, litter, and pleasantness in the neighborhood) and health status (overall self-rated health and depression) are mediated by overall sleep quality (measured as self-rated sleep quality and physician diagnosis of sleep apnea). We find that perceptions of low neighborhood quality are associated with poorer self-rated sleep quality, poorer self-rated health, and more depressive symptoms. We also observe that poorer self-rated sleep quality is associated with poorer self-rated health and more depressive symptoms. Our mediation analyses indicate that self-rated sleep quality partially mediates the link between perceived neighborhood quality and health status. Specifically, self-rated sleep quality explains approximately 20% of the association between neighborhood quality and self-rated health and nearly 19% of the association between neighborhood quality and depression. Taken together, these results confirm previous research and extend the generalizability of the indirect effect of perceived neighborhood context on health status through sleep quality.

Neighborhood Factors as Predictors of Poor Sleep in the Sueño Ancillary Study of the Hispanic Community Health Study/Study of Latinos

“…These findings are consistent with previous studies that reported an association between short sleep duration and low neighborhood safety. [10][11][12][13][14][15][20][21][22] These prior studies however, relied on self-reported sleep duration, raising concern that the associations might reflect known systematic biases in the accuracy of self-report, rather than an actual effect on sleep per se. Our results demonstrate that the perception that one lives in an unsafe neighborhood is associated with an objective measure of short sleep.…”

“…11 In contrast, a number of studies have reported associations between unsafe or crime-ridden neighborhoods and poor sleep quality. [10][11][12]20,21 However, the questions used to assess sleep quality in these studies have never been validated and so the relevance to clinical insomnia symptoms is uncertain.…”

“…[2][3][4][5][6][7][8][9] More recently, studies suggest that residents of disadvantaged neighborhoods may also be at greater risk of disturbed sleep. 10 This suggests that effects of neighborhood characteristics on sleep may represent one pathway by which neighborhood environment has an impact on health outcomes. Exposure to violence and crime and feeling unsafe in one's neighborhood have been associated with reductions in both sleep duration [11][12][13] and sleep quality, 10,[12][13][14] and worse insomnia symptoms.…”

“…10 This suggests that effects of neighborhood characteristics on sleep may represent one pathway by which neighborhood environment has an impact on health outcomes. Exposure to violence and crime and feeling unsafe in one's neighborhood have been associated with reductions in both sleep duration [11][12][13] and sleep quality, 10,[12][13][14] and worse insomnia symptoms. 15 Similarly, increased noise in the neighborhood has been associated with higher prevalence of self-reported sleep disturbances.…”

“…11,[15][16][17][18][19] However, a major limitation of the existing literature linking adverse neighborhood features such as crime and violence with sleep has been the reliance on unvalidated measures of sleep. [10][11][12][13][14][20][21][22] While studies using actigraphy have evaluated the relationship between sleep and noise, these studies have been limited by small sample size, in-laboratory testing or low levels of noise that may limit generalizability of findings. 23,24 Our goal was to evaluate the relationship between neighborhood environment and validated measures of sleep in a large cohort of US Hispanics/Latinos, the largest racial/ethnic minority group in the United States and a group with a high prevalence of cardiovascular disease risk factors such as diabetes, obesity, and hypertension.…”