A Mixed Methods Approach for Developing Culturally and Ecologically Appropriate Interventions for Improving Sleep Health in a Community-Based Sample of African Americans

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Project Summary (Abstract) High and uncontrolled blood pressure (BP) is a significant public health burden; therefore it is important to improve modifiable risk factors such as sleep health in efforts to reduce the societal burden, particularly among health disparate populations. The goal of this K01 is to utilize a mixed methods approach to design a pilot study aimed at improving sleep in the context of environmental stressors, with a long term aim of improving BP control and overall health of African Americans (AAs) who chronically suffer from poor sleep and are at high risk for hypertension (HTN) and HTN-associated comorbidities and mortality. I propose to: 1) Test independent and interactive associations between environmental (within the home and neighborhood) and social stressors (i.e. discrimination) with sleep patterns in an urban AA population; 2) Conduct qualitative research to inform the development of tailored interventions for improving the inter-related problems of healthy sleep and BP control in AAs, particularly to enhance understanding of several topics including the barriers and opportunities to improve sleep and related cardiovascular risk factors; and 3) Use data from the mixed methods research to develop and pilot a 12-week feasibility trial in a community setting with the primary objective to improve sleep as a strategy to improve BP control as well as other health outcomes. To address these research aims, I will leverage the infrastructure of the NIH and EPA funded Center for Research on Environmental and Social Stressors in Housing across the Life Course (CRESSH) co- directed by the primary mentor of this proposal. CRESSH has two projects that will be leveraged: 1) Home- based Observation and Monitoring Exposure study of a multiethnic mixed income population in Boston, MA; and 2) the Mapping Spatial Patterns in Environmental Health Disparities study. I will utilize existing data from CRESSH (7 days of real time monitored environmental stressors (noise, temperature, NO2, PM2.5, ultrafine particles, ventilation) and social stressors) as well as prospectively collect new data among AAs sampled from CRESSH and the same communities as CRESSH participants. I propose to conduct: a) 7-day wrist actigraphy to characterize sleep/wake times, sleep timing and quality of sleep; b) in-depth focus groups to identify barriers and opportunities for improving sleep; and c) complete a home environmental audit to characterize the physical and social environment. The overall goal of this career development award is to develop an independent research program aimed at understanding the root causes of sleep health disparities and their impact on cardiovascular outcomes including HTN, and designing culturally and environmentally appropriate interventions. Through research and new training in mixed methods, community-based/behavioral interventions and environmental and cardiovascular epidemiology, this award will facilitate my transition to an independent investigator in the field of sleep epidemiology and cardiovascular health disparities and will allow my research to serve as a lever for public health interventions and policy.