Sociocultural Shifting, Sleep and Cardiometabolic Risk in African-American Women

点击翻译按钮获取中文摘要

PROJECT SUMMARY African-American women have strikingly high rates of coronary heart disease (CHD)-related death and disability compared to women of all other racial/ethnic groups. This excess burden has persisted for decades, and is on the rise among young to middle-aged women. Emerging evidence suggests that sleep disturbance (e.g., short sleep duration, poor sleep continuity) may be an important driver of CHD risk in African-American women; however, because most research on sleep disturbance in African-American women has focused on comparisons to women from other racial/ethnic groups, there are substantial gaps in knowledge about factors that might promote and protect against sleep disturbance within African-American women. Such information will be critical for the development of targeted intervention efforts to improve sleep and ultimately reduce CHD risk in this population. The proposed project is designed to examine whether and how “Shifting” -- a novel, sociocultural phenomenon hypothesized to be salient among African-American women-- might impact sleep disturbance among this group. Shifting is defined as a seemingly adaptive practice in which African-American women engage in self-altering behaviors to both fit in with dominant society and accommodate African- American men. Although documented in qualitative studies and anecdotal accounts of African-American women’s experiences over the past 30 years, empirical studies of shifting have only recently emerged, and none have focused on health. We have compelling preliminary data on early middle aged African-American women, indicating that reports of Shifting (e.g., changing speech patterns, downplaying accomplishments, self- silencing) are associated with subjective sleep disturbance and body mass index (BMI), not explained by depressed affect, or discriminatory or other chronic stressors. Building on this preliminary data, we will examine the prospective interrelationships among shifting, day-to-day psychological processes, and sleep disturbance in 400 African-American women aged 35-54 from a range of SES backgrounds. Shifting and subjective sleep quality will be measured with validated questionnaires, and sleep duration and continuity will be assessed via actigraphy over the course of 14 days at baseline, and in order to shed some light on temporality, at a 12-month follow up. In order to provide us with a more in-depth understanding of how shifting might contribute to sleep disturbance on a night-to-night basis, reports of day-to-day stress, negative affect and vigilance will be assessed via daily diaries concurrent with the actigraphy assessment over the 14-day period. Finally, we will examine whether our hypothesized relationships are exacerbated by socioeconomic status (SES), which might increase the likelihood of Shifting, or ameliorated by resilience factors that promote positive social interactions and self-care (emotional support, religious service attendance, self-compassion). An exploratory Aim will also examine linkages between Shifting, sleep disturbance, and CHD risk.