Social and Environmental Determinants of Health Equity

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Growing evidence suggests that sleep contributes to the incidence and severity of cardiometabolic conditions (e.g. obesity, hypertension, diabetes, cardiovascular disease). My objective is to investigate how physical and social environmental determinants impact racial, ethnic, and socioeconomic disparities in the relationship between sleep and cardiometabolic health. Determinants of Sleep and Chronic Disease In the past, colleagues and I have investigated associations between sleep and health conditions like obesity, type 2 diabetes (T2DM), and cardiovascular disease (CVD). We have shown that sleep disturbances are prevalent among middle-aged and older adults, and vary by race/ethnicity, sex, and obesity status. We have also shown that the high prevalence of sleep disturbances and undiagnosed sleep apnea among racial/ethnic minorities may contribute to health disparities (Chen et al, 2015; Chen et al, 2016; Jackson et al, 2015). Because of my strong interest in obesity independent of its relationship with sleep, I have also studied racial/ethnic disparities in obesity trends by socioeconomic status (Jackson et al, 2016; Jackson et al, 2013) as well as dietary (Jackson et al, 2015; Jackson et al, 2014) and body mass index (Tobias et al, 2014; Global BMI Collaboration, 2016; Jackson et al, 2014; Jackson et al, 2014; Jackson et al, 2014) influences on health and mortality. Colleagues and I have most recently reported (FY 2017 October 2016-2017) a U-shaped relationship between sleep duration and risk of type 2 diabetes with the lowest type 2 diabetes risk at 7-8 hours per day of sleep duration (Shan et al, 2016). We have also reported that sleeping difficulty is associated with an increased risk of T2DM, independent of other CVD risk factors (Li et al, 2016). I am now using data from the NIEHS Sisters Study, Multi-Ethnic Study of Atherosclerosis, and the Jackson Heart Study to investigate determinants of racial/ethnic and socioeconomic disparities in sleep health and subsequent risk of cardiometabolic dysfunction. In fact, I am finalizing a study investigating the concordance/agreement between subjective and objective measures of sleep duration among Whites, Blacks, Latinos, and Chinese participants of the Multi-Ethnic Study of Atherosclerosis to determine if reporting bias differs importantly by race. Colleagues and I have also submitted for publication an investigation of perceived inequality at work, negative spillover into the home from the perceived inequality, and subsequent risk of insomnia. Because of a strong interest in identifying upstream environmental factors that contribute to sleep health disparities, I am also developing a mixed methods project to investigate the work-sleep relationship by race and am studying the impact of factors in the physical environment like housing conditions that may contribute to disparities in sleep. Since starting at NIEHS in January 2017, my research findings have been presented at several sleep-related and epidemiological scientific conferences, including the Joint Meeting of the American Academy of Sleep Medicine and the Sleep Research Society as well as the Society for Epidemiologic Research.