The Effects of Age, Gender, Hopelessness, and Exposure to Violence on Sleep Disorder Symptoms and Daytime Sleepiness Among Adolescents in Impoverished Neighborhoods

Abstract

Although sleep problems are associated with negative outcomes among adolescents, studies have not focused on sleep disorder symptoms among adolescents living in impoverished neighborhoods and how sleep problems may be related to two factors common in those environments: hopelessness and exposure to violence. This study used data from the longitudinal Mobile Youth Survey (MYS; N = 11,838, 49% female, 93% African-American) to examine trajectories of sleep problems by age (10-18 years) among impoverished adolescents as a function of gender, feelings of hopelessness, and exposure to violence. The results indicate that sleep problems associated with traumatic stress decline with age, with four notable distinctions. First, the steepest decline occurs during the early adolescent years. Second, the rate of decline is steeper for males than for females. Third, exposure to violence impedes the rate of decline for all adolescents, but more dramatically for females than for males. Fourth, the rate of decline is smallest for adolescents with feelings of hopelessness who also had been exposed to violence. To explore the generalizability of these results to other types of sleep disorders, we analyzed cross-sectional data collected from a subsample of 14- and 15-year-old MYS participants (N = 263, 49% female, 100% African-American) who completed a sleep symptoms questionnaire. Four results from the cross-sectional analysis extend the findings of the longitudinal analysis. First, the cross-sectional results showed that symptoms of apnea, insomnia, nightmares, and restless legs syndrome or periodic limb movement disorder (RLS/PLMD), as well as daytime sleepiness, increase as a function of hopelessness. Second, symptoms of insomnia, RLS, and nightmares, as well as daytime sleepiness, increase as function of exposure to violence. Third, symptoms of insomnia and RLS/PLMD are greater under conditions of combined hopelessness and exposure to violence than for either condition alone. Fourth, symptoms of RLS/PLMD are worst for females who have been exposed to violence and experience hopelessness. Overall, the findings suggest that hopelessness and exposure to violence have negative independent and multiplicative effects on adolescent sleep, particularly for females. Understanding the causal factors associated with inadequate sleep in impoverished adolescents is important for three reasons. First, sleep is an important aspect of adolescent development. Second, inadequate sleep has severe consequences for adolescent morbidity, mortality, and overall quality of life. Third, impoverished adolescents are at the most severe risk for poor outcomes, and improvement in their sleep may produce large gains.

Advancing a Biopsychosocial and Contextual Model of Sleep in Adolescence: A Review and Introduction to the Special Issue

“…These findings provide compelling support for the role of social-cognitive processes in understanding how violence exposure can impact sleep functioning. In another longitudinal study, Umlauf et al (2015) extended previous work with the Mobile Youth Survey (Umlauf et al 2011) by showing violence exposure and hopelessness to have independent and multiplicative effects on adolescent sleep trajectories, with trauma-exposed females at particular risk for subsequent sleep problems related to traumatic stress. These studies provide excellent examples of integrating the community context into models of adolescent sleep.…”

“…Studies by Kliewer and Lepore (2015) and Umlauf et al (2015) draw our attention to ways in which exposure to violence can impact sleep functioning. Among 362 young adolescents (ages 11-14 years) who witnessed or experienced community violence, both victimization and witnessing violence were longitudinally correlated with sleep problems (Kliewer and Lepore 2015).…”

Recent Updates in the Social and Environmental Determinants of Sleep Health

“…These studies find that a range of sleep measures, including sleep quality, sleep duration, insomnia symptoms, and sleep latency, are adversely associated with living in neighborhoods that are characterized by disorder, low social cohesion, and low socioeconomic status. These patterns have been observed among adults [4–11], adolescents [12, 13], and, to a lesser extent, children [14]. …”

Physiology and assessment as low-hanging fruit for education overhaul

“…A longitudinal survey of 11,838 adolescents (10-18 years old) found that hopelessness and exposure to violence produce negative independent and multiplicative impacts on adolescent sleep, particularly for females (Umlauf, Bolland, Bolland, Tomek, and Bolland 2015). To investigate how SES affects sleep habits in U.S. preschoolers, researchers assessed 3217 children (*3 years old) for the presence, time, and consistency of bedtime routines.…”