Sleeping well in a changing climate: The effects of rising temperatures and extreme weather events on sleep and other aspects of health in rural Appalachia

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Insufficient sleep (habitual sleep duration of ≤6 hours) is a costly public health problem that is more prevalent among health disparity populations (e.g., racial minorities, adults of low socioeconomic status). Climate change and climate-sensitive disasters demonstrate a detrimental impact on sleep and associated downstream health outcomes. Increasing temperatures are linked to diminished sleep time and quality, and negative impacts are heightened among populations with fewer economic resources. Extreme weather events due to climate change often result in displacement, trauma, and economic instability; these stressors directly impair sleep. The fast- growing burden of climate-related disaster recovery disproportionately disadvantages populations with existing health disparities. These data hold direct relevance to our parent R01: Researching Equitable Sleep Time in Appalachia (REST-KY; MD016236). REST-KY focuses on rural Appalachian adults, whose serious health inequities include multiple health morbidities, premature mortality, and high rates of insufficient sleep. While our project was designed to evaluate mechanisms contributing to pre-existing regional sleep and health deficiencies over a two-year period, Appalachian Kentucky’s July 2022 climate-change-related catastrophic flood event has led us to broaden the scope of our research. We will recruit a cohort of 400 adults from 6 insufficient sleep “hotspot” counties (n=200) in Appalachian KY (where 25-58% of adults report insufficient sleep 15+ nights/month), and 6 similarly rural and economically distressed non-“hotspot” counties. Five of the 12 counties suffered widespread flood damage. The use of a mixed method, longitudinal burst design in the parent R01 will allow us to evaluate mechanisms contributing to both sleep deficiencies and health over two years in this rural community. The present supplement is responsive to the NOT-HD-23-006 NOSI and addresses three of the four core pillars of the NIH Climate Change and Health Initiative (Health Effects Research, Health Equity, and Training and Capacity Building) by expanding our trans-disciplinary team to bring together climate and health scientists. The proposed activities are fully within the scope of the aims of the parent R01: a) collect objective measurements of outdoor and indoor temperature, humidity, and barometric pressure as additional predictors of objective sleep health; b) add quantitative measures of beliefs about climate change and health to examine associations with sleep and other health outcomes; and c) add quantitative measures and conduct supplemental qualitative interviews with flood survivors in the parent R01 cohort to evaluate perceptions of factors contributing to the flood disaster (including climate change), how the flood impacted their sleep and health, and long-term recovery resources and needs. Our findings will offer unprecedented insight into the intersections of climate change, sleep and health in an understudied rural health disparity population. Results will inform strategies to increase health equity in the face of a rapidly changing climate, and thus will have strong potential for public health impact.