Incarceration, Sleep Health, and Cardiovascular Disease Risk

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PROJECT SUMMARY An estimated eleven million individuals are released from U.S. jails and prisons each year. Individuals with a history of incarceration have higher rates of cardiovascular events and mortality compared to the general population, especially in the weeks following release. An especially underexplored factor in the epidemiology of cardiovascular disease in this population is sleep health. Incarcerated people may have unique reasons for being sleep deficient at the individual, environmental, and institutional policy levels. They have higher rates of mood disorders and chronic pain, which amplify sleep deficiency. Exposure to extreme temperatures, noise, and light within correctional facilities and halfway houses may impact sleep. Exposure to violence and the conditions of confinement are associated with increased rates of psychosocial stress or post-traumatic stress disorder, contributing to sleep-disrupting nightmares and insomnia. The overarching aim of this study is to understand how incarceration, especially correctional and post-release social and physical environments, contribute to sleep deficiency and cardiovascular disease risk. The central hypothesis of this study is that sleep deficiency is associated with the factors in the social and physical environment during incarceration and after release. I propose a mixed methods study with the following aims: 1) Identify population-specific risk factors in the social and physical environment that contribute to sleep deficiency during and after incarceration and potential opportunities to improve sleep health; 2) Characterize using geospatial analysis the environmental factors during incarceration and post-release that may contribute to sleep deficiencies; 3) Develop and pilot instruments to assess sleep deficiency and sleep environment among people with a history of incarceration. To achieve these aims, I will leverage the existing infrastructure of an ongoing NHLBI R01 study (JUSTICE, 1R01HL137696-01A1) and the expertise of the SEICHE Center for Health and Justice, the Yale Program in Sleep Medicine, the Sleep and Health Research Program and Behavioral Sleep Medicine Program at the University of Arizona, and the National Environmental Institute of Environmental Health Sciences (NIEHS) Social and Determinants of Health Group.The proposed research and training in sleep medicine and cardiometabolic outcomes, environmental factors in sleep health, and intervention development will facilitate my transition to a career as an independent researcher in sleep health disparities among people with a history of incarceration and position my research to impact public health interventions and policies.