Social and Environmental Determinants of Health Equity

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Our current work focuses on environmental epidemiology, behavioral and social science, and health inequities related to sleep and cardiometabolic health. Employing a global perspective, we sought to highlight the importance of considering sleep health when addressing global public health as well as when addressing climate change adaptation, mitigation, and resiliency. Most countries especially developing countries do not adequately include sleep health in public health policy. We recommended several equitable strategies to accomplish this goal (e.g., sleep health education, awareness, and policy development). Further in an Editors choice commentary, we emphasized that additional research of climate change in relation to sleep health that uses a life course approach and health equity lens is important to reduce the human health consequences of climate change. Related to health equity, we published a commentary that underscored the need to study racism as an upstream, fundamental determinant of observed sleep health disparities. We recommended advancement of the sleep research agenda by focusing on racism a potential intervention target rather than race and offered several recommendations, strategies, and best practices to accomplish this goal. As in illustrative example in a separate commentary, we discussed how inequities related to structural racism, namely differential access to care, may perpetuate sleep health disparities. Using data from the Health Resources and Services Administration (HRSA), we demonstrated a major disparity in access to sleep medicine specialists, illuminating the urgent need for the sleep field to address access to care gaps among underserved populations. In the environmental health realm, we sought to provide information about exposure to light at night in relation to sleep health disparities that can be used to prioritize intervention strategies. Using data from the Sister Study, we found that both sleeping with light from the television and multiple poor sleep dimensions were most prevalent among non-Hispanic Black women compared to non-Hispanic White and Hispanic/Latina women. Further, light from the television was associated with most poor sleep characteristics. Lastly, data suggested that interventions aimed at reducing indoor light at night may be most efficacious among Black women, which has implications for reducing sleep health disparities. Related to nutrition and the food environment, we used National Health Interview Survey (NHIS) data collected from adult participants and found that very low versus high food security was associated with a higher prevalence of short sleep duration as well as sleep disturbances. Intervention and mitigation strategies addressing food access and quality may aid in improving sleep health among US adults. Additionally, the neighborhood environment has been associated with sleep health; however, data is sparse concerning specific features of the neighborhood environment that impact sleep. Therefore, we collaboratively investigated the relationship between perceived walkability and sleep health among US adults using NHIS data and found that both places to relax and pedestrian accessibility were associated with better sleep while unsafe walking conditions were associated with poorer sleep health. Likely pathways explaining associations may be, for instance, through safe walking environments increasing opportunities for physical activity, which can promote healthy sleep. We also found the neighborhood social environment feature of perceived neighborhood social cohesion as associated with a higher prevalence of two cardiometabolic health outcomes associated with poor sleep both obesity and type 2 diabetes among NHIS participants. Associations may be driven through, for instance, shared access to resources and promotion of health behaviors. Further associations varied by age, sex, and race and ethnicity. Tailored neighborhood-level interventions that consider lived experiences across complex, intersectional identities related to belonging to multiple sociodemographic groups may address cardiometabolic health disparities. We also performed timely research about the impacts of COVID-19 among a racially and ethnically diverse population. Using data from the nationally representative COVID-19s Unequal Racial Burden (CURB) survey, we found high burdens of both financial hardship and sleep disturbances among women and certain minoritized racial and ethnic groups. Further, financial hardship was associated with a higher prevalence of moderate to severe sleep disturbances. While these associations did not differ by gender, associations were strongest among Black/African American adults. In the same sample, perceptions of people acting afraid of you because they think you might have COVID-19 was associated with moderate to severe sleep disturbances across racial and ethnic groups. Interventions promoting financial security and reducing discriminatory practices in the US my address and reduce the likelihood of exacerbation of sleep health disparities subsequent to the COVID-19 pandemic. Given prior linkages between circadian rhythms, which drive sleep, and cognition among aging populations, we, along with collaborators, investigated longitudinal associations between circadian rest and activity rhythms with cognition among adults of Black, White, and other races and ethnicities. Results supported that delayed circadian phase is associated with poorer memory performance and that circadian rest and activity rhythms are more strongly associated with higher rates of cognitive decline among women, Black adults, older individuals, and individuals with genetic risk factors compared to men, non-Hispanic White adults, younger individuals, and individuals without genetic risk factors, respectively. In collaboration, we also investigated disparities in diagnosis and treatment of obstructive sleep apnea and found that underdiagnosed/untreated individuals were more likely to belong to a minoritized racial or ethnic group, be uninsured, have lower educational attainment, have lower household incomes, and identify as women. Therefore, addressing barriers to access to care may mitigate disparities in sleep apnea.